Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to staff Cristine Baylon. Administrator Jasmin Tomines was explained the purpose of the visit telephonically. The facility is licensed as a level 4i Adult Residential Facility serving developmentally disabled residents 18-59 years.

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

Physical Plant/Environment Safety: The facility is single story home located in a residential neighborhood. It consists of 3 resident bedrooms, 1 office room, living room, dining room, kitchen, 2 bathrooms, laundry room, attached garage, and backyard patio area. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operational. The facility one (1) fire extinguisher. Water temperature readings measured 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.

Operational Requirements: Fire clearance is approved for four (4) ambulatory only residents. Care and supervision to meet the clients needs was observed. No special equipment is used by residents. The Surety Bond is current.

Staffing: A total of 5 staff members provide care and supervision to the clients.