Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Mylyn Castillo, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasado 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, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

· Infection control plan was not present in facility.

· The facility is a single-story home located in a residential neighborhood. The facility consists of four (4) resident bedrooms, a multipurpose room, a kitchen, dining room, a living room, and two (2) resident bathrooms which both fell within the required range of 105 – 120 degrees Fahrenheit. The carbon monoxide detector is operational in the home. A fully charged fire extinguisher is kept on the premises.

· LPA was not permitted to inspect Bedroom #1 or the garage of the facility. Administrator claims that this is a separate address, however it is still part of the same address according to the facility sketch and plan of operation that is held with the licensing agency.