Facility Evaluation Report

Licensing Program Analyst (LPAs), Armando Perez and Ferrer Sabarias made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs was granted entry by staff to conduct the inspection and met with administrator, Jerome Bayaua. The inspection included the following:

The facility consists of five bedrooms, three bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Administrator, no weapons are stored in the home. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. The carbon monoxide and smoke detectors were tested and observed to be in operating condition. LPAs observed a fire extinguisher in living room area with an expiration date of July 3, 2025. The home was kept clean and free of any odors.

LPAs began review of client records. Four (4) records were reviewed. LPAs 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. LPAs observed missing Identification records for two clients and an emergency consent form for one client. Administrator will be submitting proof to LPAs of the required forms.

LPAs began review of employee records- Two (2) records were reviewed. LPAs reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and administrator certification with an expiration date 05/17/2024. The administrator provided documentation that confirms payment and submission of the renewal administrator application with the date of 04/25/24.