Facility Evaluation Report

On 05/03/2023 at 9:45am, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Facility Designated Administrator (FDA) Delois Bunch and Licensee Charles Wiliams and explained the purpose of the visit. There was one other staff member present at the facility, Jorge Chanax.

This facility is licensed to serve up to 6 ambulatory residents at this time. This facility is also vendorized by Valley Mountain Regional Center to accept and retain Level 4I residents.

Current census was 5. 5 out of 5 residents were out at their respective day programs.

LPA reviewed 7 staff files and 5 resident files. All resident and staff files were current and up to date. The FDA currently holds an active and current certificate #6010183735 and expires on 02/21/2024.

A tour of the facility was conducted with FDA Bunch and Licensee Williams.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Armor Fire Extinguisher company and is valid until 08/03/2023. The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable and non-perishable food supplies were identified in the garage. Knives were observed to be locked under the kitchen sink and made inaccessible to the residents at this time.

LPA observed a locked centralized stored medication cabinet located in the hallway. Along with a staff member, the LPAs observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time