Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with staff Merly Campos and explained the purpose of the visit. Administrator Josefina Bernal arrived shortly after. There are five (5) ambulatory level 4C developmentally disabled clients in the home. The facility is a single story home located in a residential neighborhood. It consists of 3 client bedrooms, 1 live-in staff room, 2 bathrooms, dining room/family room, kitchen/dining area, living room, outdoor patio, and attached garage. The last fire/emergency drill was conducted on 8/6/2022. Administrator certificate expires 2/25/2023.

The interior and exterior physical plant was inspected. The facility is equipped with a fire pull alarm system. Smoke and carbon monoxide detectors were tested and operational.

COVID-19 Infection Control Practices and signs that promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, bathrooms and client rooms. There is a screening station at the entrance of the facility to screen visitors.

The staff room is designated as a COVID-19 isolation room if needed.

A posted Emergency Disaster Plan was observed.

Three (3) centrally stored client medication records were reviewed. Medications are documented properly and given as prescribed.

Staff were observed wearing mask. Clients do not wear masks due to disability exemption.

The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food.

Water temperature was within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C).

Facility has an adequate 30-day+ supply of Personal Protective Equipment (PPEs).

The facility submitted a COVID-19 Mitigation Plan and Infection Control Plan.

An Infection Control Plan (ICP) has not been submitted. Submit the ICP as soon as possible A technical assistance advisory note was issued.

NOTE: The cabinet under the kitchen sink was unlocked. Disinfectants and knives/sharps were unlocked. In addition, room #2 has a hole in the wall, and room #3 has a torn door screen, and dirty wall.

Exit interview was conducted with Josefina Bernal. A copy of the report and appeal rights were issued.