Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Maria Mendoza. The facility is licensed for 6 ambulatory clients. Currently there is one client living here during today's visit.

At 1:35 PM, LPA Tea reviewed one client file and two staff files. Client files and staff files contained all required documentation except one minor issue with the admission agreement on file for the client. The form LIC604 was used as the admission agreement, LPA advised that the LIC604 is not an admission agreement but to be used only a a guide to create an admission agreement. The administrator certificate expires on April 4, 2025

LPA Tea along with the administrator toured the facility around 2:50 PM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a one-story home that consist of five bedrooms, three are reserved for client bedrooms, and two are staff rooms, and two and a half bathrooms. The facility has a kitchen, dining room, and living room, family den and a garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. 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 around 105.8 F degrees. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a storage cabinet in the family den. LPA also observed toxin substances to be secured and locked and inaccessible to clients in a storage closet in the family den.