Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Case Manager (CM) Katie Ornette and Direct Support Professional (DSP) Peyerre Hart and was granted entry into the facility. Administrator Arrellano arrived a short time later to be present for the inspection. The facility is licensed to serve four (4) clients of whom all four (4) must be ambulatory.

During today’s visit, LPA Correia, accompanied by Administrator Arrellano, toured the interior and exterior of the facility. LPA observed the exterior and interior of the facility to be sanitary and in good repair. LPA observed a First-aid Kit and manual, required postings, shaded area in the backyard, and activities for clients in care. The fire extinguisher was up to date, and smoke alarms and carbon monoxide detectors were present and operable. The facility is licensed to serve four (4) clients of whom all four (4) must be ambulatory. During the facility tour LPA observed pathways were well lit and free of obstruction and slip hazards. All clients had private rooms, allowed for easy passage, that contained all the required furnishings. Toilet and shower were in working order. The facility’s ambient internal temperature was 72 F. Due to clients in care taking showers at the time of today's inspection Administrator Arrellano provided a copy of the daily log of documentation of water temperature checks by facility staff for the month of February. Per Administrator Arellano there are no firearms, weapons, or ammunition on the facility premises. LPA observed no bodies of water on the premises. Client and staff records were present an up to date. LPA observed an adequate supply of PPE, personal hygiene supplies, and observed 2 days of perishable food and 7 days of non-perishable food to meet the clients dietary needs. The facility had an adequate supply of clean linens, PPE, and hygiene supplies.

No deficiencies were cited during today's visit. This report was discussed with Administrator Arrellano. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.