Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/23/23 at 3:30pm to conduct a Case Management - Deficiencies visit. LPA met with Caregiver(s) Michelle Perez and Elvis Perez and stated the purpose of the visit. Michelle Perez, Caregiver was unable to contact Arlene Gomez, Administrator regarding todays visit. Michelle stated that Arlene Gomez submitted a plan of correction to the Community Care Licensing Office.

Observations during this visit regarding Deficiencies that were cited on 12/10/23:

-Administrator certificate expired 5/18/23 for Arlene Gomez. LPA did not observe an Administrator certificate for Jose Nevarez nor supporting documents with proof of payment for renewal for neither. Michelle Perez, Caregiver stated that the file has not been updated with pertinent documentation or proof of payment to renew. She also stated Arlene Gomez has not received the renewal yet. NOT CLEARED TO BE RE-CITED

-LPA did not observed an updated LIC308 Designation of Responsibility NOT CLEARED TO BE RE-CITED

-LPA did not observe a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, tweezers, and antiseptic solution. Michelle stated it was ordered and it has not been delivered yet. NOT CLEARED TO BE RE-CITED

-LPA did not observe TB results for staff. Michelle stated regarding the TB for staff Arlene Gomez is working on it. NOT CLEARED TO BE RE-CITED

-LPA inquired with both staff regarding the Infection Control Plan. Michelle has not received a copy of the Infection Control Plan. NOT CLEARED TO BE RE-CITED

-LPA observed medications belonging to staff accessible and on top of refrigerator not locked. - LPA observed the same medications on top of the refrigerator which was removed during this visit. A photo was taken. NOT CLEARED TO BE RE-CITED

- During file review LPA observed expired first aid/CPR certificates for staff. Michelle stated regarding the First Aid/CPR for staff Arlene Gomez is working on it. NOT CLEARED TO BE RE-CITED