Facility Evaluation Report

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by Direct Support Professional (DSP) Yaarah Cruz after explaining the purpose for today's visit. LPA observed that Administrator (AD) Carmen Cruz has a valid Administrator certificate which expires on October 12, 2026.

The facility an Adult Residential Facility (ARF) level 3 licensed for six ambulatory clients. The facility is a two story home with three client bedrooms, all of which are located on the first floor, 1 shared client bathroom, also located on the first floor, five additional bedrooms that are used by the Administrator and their family, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the DSP, conducted a tour of the interior portion of the facility. On today's visit, all five clients were away attending their respective Day Programs. LPA inspected the three client bedrooms and observed them to be free of hazards. LPA observed client bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed client beds to have clean linens and blankets. LPA observed linens to be stored in a hallway closet in each client's closet. LPA tested the individual smoke detectors in each of the client rooms which tested operational. LPA inspected the shared client bathroom and observed it to be clear of any hazards. The faucet and toilet was operational. Hot water temperature measured 119.4 degrees Fahrenheit. LPA observed the two bedrooms located on the second floor of the home to be off limits to clients in care and are used by the Administrator's family. LPA observed the doors for the staff bedrooms are kept locked and inaccessible to clients in care.

LPA observed the facility has a two day perishable and a seven day nonperishable food supply on hand. CONTINUED ON 809-C