Facility Evaluation Report

Licensing Program Analyst (LPA) Noemi Galarza made an unannounced annual inspection visit. The purpose of the visit was explained to reliever staff Angelina Respicio. Caregiver staff Flordeliza "Lourdes" Rosana arrived later. Licensee/Administrator was notified telephonically of the visit. The facility is an Adult Residential Facility (ARF) that serves mentally disabled residents ages 59 and under.

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities.

Physical Plant/Environment Safety: The facility is a single story home consisting of 4 bedrooms [3 resident & 1 live-in staff room], 2 bathrooms, kitchen, dining room, living room, attached 2-car garage with laundry area and additional refrigerators, and an outdoor backyard patio area. The front yard is landscaped with grass and the rear backyard has cement. Smoke and carbon monoxide detectors were tested and are operational. The facility has one (1) fire extinguisher and a fire pull alarm. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. Exit doors are free of any obstruction and there are no pools or large bodies of water.

* There are 2 cats in the home. A mattress, shower chair, walker, and storage boxes were observed in the backyard patio area.

Operational Requirements: Fire clearance is approved for six (6) ambulatory residents. Care and supervision to meet the clients needs was observed. Special equipment and supplies are not used by residents. The facility does not handle resident monies. Therefore a Surety Bond is not required.

Staffing: A total of 3 staff members provide care and supervision to the clients.