Facility Evaluation Report

At approximately 2:30PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Dora Rodas De Leon. Administrator, Agnes Dizon, arrived at approximately 2:50PM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance and capacity for 6 Ambulatory Clients. Upon arrival, LPA was informed that there were 4 clients in care with all four clients out of the facility with family or attending Day Program. LPA was also informed that there was one staff member on-site.

At approximately 2:40PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 2:55PM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 5 Client bedrooms, 2 bathrooms, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPA observed that client bathrooms do not have trash cans with lids (See technical advisory, LIC9102, Regulation 80088(f)(1)). Per conversation with Administrator, none of the clients require assistance with incontinence care. LPA reviewed client files and confirmed that none of the clients require assistance with incontinence care.

At approximately 3:15PM, LPA reviewed staff files, client files, client medication, and client P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. P&I monies were documented, secure and not commingled. Administrator's Certificate for Agnes Dizon (6026680735) was current with an expiration date of 04/23/2025.