Facility Evaluation Report

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Dwayne Mason Jr. for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Staff #1 (S1) Gretchin Ramos and discussed the purpose of the inspection. Administrator (AD) Shelly Martinez arrived during the inspection.

LPAs reviewed Infection Control requirements. At about 8:30AM, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, and garage and observed the following: Structure: this is a one-story home. Facility is a 4-bedroom, 2-bathroom, one-story house with a detached garage that is being used for storage. There is a back yard with a patio cover for the clients. LPAs observed 4 staff and 1 client present at the facility. Client Bedrooms: the 3 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Staff Bedrooms: LPAs inspected the 1 staff bedroom. Bathrooms: bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 111.5 degrees F in the west bathroom and 107.9 degrees F in the east bathroom. LPAs inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked in the laundry room and kitchen. Medication cabinet is locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:00AM, LPAs reviewed 6 client files and 5 staff files, interviewed 1 client and 4 staff, inspected medications for 6 clients, and inspected client money and ledgers for 6 clients.