Facility Evaluation Report

On 10/12/2023, at about 1:10 PM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Alma Sediego, Supervisor. LPA reviewed the Mitigation Plan Report. According to the facility’s license, the facility serves six (6) adult clients, ages 18-59; all of whom may be non-ambulatory. Rooms 1,2,3,4 approved for non-ambulatory. RHCP approved for insulin dependent diabetics and gastrostomy feeding. On the day of the inspection all clients were ambulatory. There were no diabetic clients nor clients using gastrostomies.

LPA Pena, accompanied by Ms. Sediego, toured the interior and exterior of the facility, and inspected each room. The facility was organized, kempt, in good repair and contained no offensive odors. 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 client activities.

There was at least two days of perishable food, and at least seven 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 were on the premises. Per Ms. Sediego, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were