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 Judy Nelson, caregiver for the facility, and explained the purpose of the visit. Administrator Marsha Haywood was notified of the visit by telephone. There are six (6) 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.

· Infection control practices were observed. LPA observed that the facility has a completed infection control plan.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of six (6) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of three (3) shared client bedrooms, a kitchen, a living room, a game room, a dining room, an attached garage that contains the laundry machines, a backyard with shaded area with a locked storage shed that contains tools, and a client restroom which had a hot water temperature reading of 109.7 Degrees Fahrenheit. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.