Facility Evaluation Report

Licensing Program Analysts (LPAs) Janira Arreola and Jacqueline Shaw Ross conducted an unannounced annual required visit on 3/17/2023 at 09:30 a.m. LPA was granted entry and met with program Director, Terry Woodrow, who was informed of the purpose of the visit.

The facility is a one story facility with (4) activity room and (5) bathrooms for clients between the ages of 18 and above. LPA conducted a tour of the interior and exterior of the facility and observed the following:

Infection Control: The LPA observed the hand washing stations in the facility had a hand washing sign with proper steps on hand washing. LPA also observed gloves in client restrooms and changing areas, and cleaning supplies to do regular cleaning of the facility. The facility is currently screening clients when coming to the program. The facility was not able to present the LPAs with a copy of the infection control plan. LPA will issue a technical note for this to be available at the facility.

Physical Plant: LPA observed activity materials in activity rooms. Physical plant, floors, windows, and doors were observed to be clean and in good repair. Fixtures and furniture were in good repair and were present. There is an adequate number of activity rooms for the capacity of the facility. The outdoor area was observed to have a shaded area for clients and was free of hazards. Chemicals were observed in a locked maintenance closet. LPA will issue technical advisory note for staff to place blender in a locked cabinet to make it inaccessible to clients. LPAs observed (2) buckets on the floor of the facility file room, and asked the staff about leak in the ceiling. LPA was informed that communication with building management on repairs that were actively being conducted. This room is not accessible to consumers. The hot water temperature was recorded at 119F in one of the client restrooms.

Food Service: LPA observed kitchen used to store client lunches. The LPA observed Goldfish snacks that had a sell by date of 1/15/2023. LPA will document a technical advisory note for staff to discard these as there is no expiration date to verify freshness. LPA observed the kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition.