Facility Evaluation Report

Licensing Program Analyst (LPA) Javina George conducted an unannounced annual/1 year required visit on April 25, 2023 at 10:00am. LPA was granted entry by Caregiver Edwin Nunez, who was informed of the purpose of the visit. The Administrator Cheryl Balquiedra was not able to come to the facility, but was available via telephone.

The facility is a single story home with (4) bedrooms and (1) bathroom designated for the clients to use and there is one (1) bedroom fr or staff and one (1) bathroom available for both the clients and staff to use. During LPAs visit, LPA conducted a tour of the interior and exterior of the facility and observed the following:

Infection Control: LPA observed for the facility to have Personal Protection Equipment (PPE) supplies, and covid postings such as donning and doffing PPE proper hand washing to help minimize the spread of germs. The facility does not have an approved mitigation plan (LIC808) on file, Per the Administrator Ms. Cheryl Balquiera it was not completed as there were not any clients in care during the declared state of emergency. The Administrator agrees to submit the mitigation plan to the department by 5pm Friday 4/28/2023. If not received, than a deficiency will be cited.

Physical Plant: LPA observed the clients bedrooms which contained the required furniture. The interior and the exterior were observed to be clean, odor and clutter free. The floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair. The facility does not have a pool or any other bodies of water on the premises. The water temperature was tested and was found to be within regulatory limits 105.6-110.8 degrees Fahrenheit.

Food Service: LPA observed the kitchen to be clean and possess equipment in good working condition. LPA observed the facility had the required 2-day perishable and 7-day non-perishable food supplies. The sharp and dangerous objects are kept locked in a drawer of the island in the middle of the kitchen.