Facility Evaluation Report

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Alexandra Calderon. The facility was licensed for a capacity of four (4) clients. At the time of the visit the facility had four (4) clients in care.

The LPA, accompanied by caregiver, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water on the premises. Per staff, no firearms or ammunition were kept at the facility. Carbon monoxide detectors, and Fire extinguisher were present.

The LPA conducted interviews of staff and client and reviewed staff and client records. Staff records were not present at the time of the visit. This deficiency was cited in an LIC 809D and a Plan of Correction was jointly formulated with Caregiver Alexandra Calderon.

An exit interview was conducted with Calderon, to whom a copy of this report, LIC 809D and the Licensee/Appeal Rights (LIC9058 03/22), were provided.