Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Co-Licensee/Administrator Yoanne Crisostomo. LPA also met with House Manager Guadalupe “Lupita” Perez-Barraza, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of whom all must be ambulatory. According to LIC602 Physician’s Reports, staff interviews, and LPA observation: During this annual inspection, there were a total of four (4) clients in care, and all were ambulatory per their respective doctors. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were used at the facility.

During this inspection, LPA interviewed multiple clients and multiple staff. LPA reviewed the care and administrative records for all clients and the personnel and training files for all staff. The files reviewed were complete/complaint. LPA also toured the interior and exterior of the facility and inspected all common areas and bedrooms. 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, hygiene, and Personal Protective Equipment (PPE) 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 69 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen Sink was 109.4 F, Bathroom #1 Sink was 112.6 F, and Bathroom #2 Sink was 114.3 F. Appliances to preserve perishable food were also complaint in temperature: both Kitchen Refrigerators were 40 F, and both Kitchen Freezers were 0 F. [CONTINUED ON LIC 809-C]