Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA explained the purpose of the visit with DSP Mitzi Beltran. Administrator Nayeli Nolasco arrived shortly after. There are six (6) clients level 4i specialized developmentally disabled clients ages 59 and under. Facility is a one-story home licensed for 6 ambulatory only clients. It is located in a residential area consisting of five (5) client bedrooms, 3 bathrooms, kitchen, dining room, living room, covered patio area, and detached garage with laundry area. The facility has a fire pull alarm system that was tested today. The last emergency disaster drill was completed on May 6, 2022. Administrator certificate expires 12/8/2023.

COVID-19 Infection Control Practices/screening area was observed in the main entrance. LPA was screened. Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Hand sanitizer was observed.

The facility has two private rooms that are designated as COVID-19 isolation rooms if needed.

Staff responsible for direct care and supervision were observed wearing a mask.

Clients were observed wearing masks in the facility common areas.

Sufficient supply of 2 day perishable food & non-perishable foods for 7 days were observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Three (3) centrally stored medication records were reviewed.

Staff (S1) was not cleared or associated to the facility.

***A deficiency was cited and civil penalty was assessed.

Exit interview was conducted with Administrator Nayeli Nolasco. A copy of the report and appeal rights were issued.