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 Cindy and Mary Grace Lalusin, Direct Support Staff for the facility, and explained the purpose of the visit. Administrator Susan Martinez was notified of the visit by phone call..

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. It consists of four (4) client bedrooms, two (2) living rooms, a dining room, a kitchen, an attached garage that contains the facility washer and dryer, and a backyard with a shaded area. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked in the kitchen of the facility as well.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no pools or bodies of water accessible to the clients. Fire alarm system and carbon monoxide detectors are operational. The facility has one (1) fully charged fire extinguisher kept in the facility. Cleaning supplies and toxic substances are kept locked and inaccessible to clients.

Due to time constraints, LPA will need to complete the annual inspection at a later date. Exit interview held and a copy of the report was provided.