Facility Evaluation Report

Licensing Program Analysts (LPAs) Carmen Lopez and Ryan Fulton conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPAs Lopez and Fulton identified themselves, was granted entry by direct support personnel LVN Shayla Saunders. LPAs discussed the purpose of the visit with DSP Saunders. Administrator Elizabeth Enriquez and office administrator Susie Davila later arrived and joined the visit.

According to the facility’s license, there may be a maximum of four (4) clients all of whom may be non-ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is 4 clients living at the facility. There were 4 clients present at the facility site during the inspection. who later left for an activity outing.

LPAs, accompanied by Administrator Enriquez 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. Doors, windows, toilets, and showers were in working order. 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 activities.

The facility’s ambient internal temperature was comfortable and compliant, at 76 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink measures hot water at 106.2 degrees F; sink in restroom #1 delivered hot water at 105 degrees F; sink in restroom #2 delivered hot water at 106.3 degrees F; sink in restroom #3 delivered hot water at 112.2 degrees F.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to clients. Medications were properly labeled, as required, and stored in locked areas. LPA inspected the medication room and found that medications were properly labeled and stored in a locked cabinet. The facility-maintained medication logs which LPA reviewed.