Facility Evaluation Report

Licensing Program Analyst (LPA's) Armando Perez and Sara Martinez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA's was granted entry by staff to conduct the inspection and met with administrator Adrienne Walker. The LPA's informed the Administrator of the purpose for the visit. The inspection included the following:

Physical Plant and Safety of Environment/Operational Requirements- LPA's toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of three resident bedrooms, 3 bathrooms, a kitchen and dinning area, a living room area, a garage, laundry room, a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 111.5 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals on the entrance hallway. All outdoor and indoor passageways are free of obstruction. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. The infectious control plan was not available and could not be reviewed. A deficiency will be issued under 22 title regulations as well as a plan of correction.

Client Records-Incident Reports/Clients Rights-Information/Dental- LPA began review of client records. Three 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.

Personnel Records/Training/and Staffing- LPA began review of employee records- Three records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification expiring in 2025.