Facility Evaluation Report

Licensing Program Analysts (LPA) Dang Nguyen and Jose De La Cruz made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee/Administrator Dulce Antonio and Manager Jerijan Antonio.

According to the facility’s license, the facility has a maximum capacity for four (4) clients, of whom all must be ambulatory. Per LPA observation, LIC602 Physician’s Reports, and interviews: During today’s inspection, there were a total of four (4) clients in care [Client #1 (C1) through Client #4 (C4)], and all were ambulatory. LPAs interviewed multiple staff and multiple clients. LPAs also reviewed the care records for all clients, and the personnel and training files for all active staff. LPAs, accompanied by Licensee, toured the interior and exterior of the facility and inspected all common areas and bedrooms.

During the facility tour, LPAs observed: In one non-locking kitchen drawer were three (3) sharp cooking knives (two had metal blades longer than six inches, and one had a metal blade less than six inches) and two (2) sharp pairs of scissors. In another non-locking kitchen drawer was a metal screwdriver with a six-inch blade. The door to one staff bedroom was unlocked, and inside this bedroom was one metal cooking knife with a six-inch blade which was in immediate plain view.