Facility Evaluation Report

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with Executive Director Valeria Garcia and Administrator Liliana Moreno. The LPA informed Valeria and Liliana of the purpose for the visit. The inspection included the following:

LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of five (5) building structures. The facility has a kitchen, dinning area, laundry room, and a courtyard and with sufficient seating and space for activities. The five villas are maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured within regulation at multiple tested locations. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. An Activities calendar and menu is available and posted at the facility. The LIC 610, emergency disaster plan and infection control plan is maintained. There are no firearms at this facility and no bodies of water observed.

LPA began review of client records. eight (8) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed two out of eight files to be missing the Admissions agreement, medical consent form and personal rights. A deficiency will be cited.