Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Eva Gallardo, house manager for the facility, and explained the purpose of the visit. There are four non-ambulatory clients residing in the facility.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of four (4) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of four (4) client bedrooms, a kitchen which also contains the washer and dryer for the facility, a living room, a dining room, a backyard with shaded area, and two (2) client restrooms which had hot water temperature readings of 114.8 and 117.4 Degrees Fahrenheit respectively. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no pools are or bodies of water accessible to the clients. The facility has three (3) fully charged fire extinguishers in the facility. Cleaning supplies and toxic substances are kept locked and inaccessible to clients.

Due to time constraints, the annual will be completed at a later date. Exit interview held, report will be provided.