Facility Evaluation Report

On this day Licensing Program Analysts (LPAs) Samer Haddadin and Fred Arias made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by Administrator (AD) Melissa Carbajal and Mindy Fajardo and explained the reason for the visit. Facility is licensed for 6 ambulatory clients. Facility currently has 4 clients. ADs Melissa Carbajal and Mindy Fajardo have valid certificates that expire on 5/25/2026. AD Carbajal provided updated liability insurance that expires on 10/24/2025.

LPAs along with Administrator Fajardo toured the facility at 1:45PM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 3 client bedrooms, living room, dining room, and kitchen as well as 2 client bathrooms. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 118.3 degrees F and 119.3 degrees F in all bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPAs toured the kitchen and observed sharps locked in a drawer during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/18/2024. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of outdoor trips. There is shaded outdoor seating for clients. Exit gate is unlocked and operational. LPAs observed the emergency food and water supply. LPAs reviewed two client files and two staff files. All client files contained required documentation including admission agreements, physician reports, and client appraisals.