Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Jave Vega. LPA then met with Administrator Jane Antonio, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of six (6) clients, of whom all must be ambulatory. Per LIC602 Physician’s Reports, staff interviews, and LPA observation: During today’s inspection, there were a total of three (3) clients in care, and all were ambulatory. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During today’s visit, LPA performed a welfare check and interviewed all clients in care and multiple staff. LPA also reviewed records for all clients in care and multiple staff. LPA, accompanied by the Licensee, also toured the interior and exterior of the facility, and inspected all common areas and resident bedrooms. Inside the facility was a cabinet which contained multiple bottles of cleaning chemicals, with an “automatic” lock on the cabinet door. When LPA first pulled on the cabinet door, it was not fully closed and latched, and therefore this cabinet was unlocked, in practice. In the facility’s backyard, LPA observed unlocked/accessible the following “items that could pose a danger if readily available to clients”: one (1) full-length axe with metal head, two (2) full-length post-hole digging tools with metal heads, and four (4) full-length shovels with metal spades.

The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was complaint at 76 F. [CONTINUED ON LIC 809-C]