Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit for the purpose of conducting the facility's Required Annual Inspection. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Clinical Director Nicolette Munoz arrived later to assist with the visit.

During the inspection LPA accompanied by staff conducted a tour of the inside and outside of the facility:

The facility is a two-story house with two shared client bedrooms (one of which has an en-suite bathroom as well) and two private bedrooms, a therapy room, a medication room, one client bathroom upstairs and one staff bathroom downstairs. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. Bathrooms faucets and toilets were operational. Water temperature tested to be within the appropriate temperature range. LPA observed all windows were screened and not equipped with security window bars. The back deck has a shaded sitting area equipped with outdoor furniture. Clients were out of the facility when LPA arrived to the facility and returned during the visit.

LPA observed and reviewed the facility's emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the facility's hallway. Menu was also posted and visible. Meals are catered by a chef for lunches and dinners on weekdays and dinners on week-ends. LPA observed the facility does have a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations.

Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged. Sharps were observed to be kept locked and inaccessible. All and any toxic chemicals, cleaning solutions, laundry detergent and disinfectants are also inaccessible to clients. Medication cabinet was observed to be locked in medication room. LPA reviewed four client files and five staff files. LPA interviewed three staff members and two clients during the visit, two other clients declined.