Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:12 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator Teresa Becerra and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety : The facility has 4 client bedrooms and 1 client bathroom currently occupying 4 clients. The Licensee lives in the facility and has 1 bedroom, and 1 bathroom dedicated for use. The staff have a staffroom and bathroom upstairs on 2nd floor and it is not currently being occupied by any staff. The facility is clean, safe and sanitary. The facility has smoke and carbon monoxide detectors were working at time of testing. The lighting and lamps are sufficient for the use of the facility and for the client’s comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to clients in care locked in a closet off living room. The facility has sufficient space inside and outside for activities and visiting. The facility has a large yard and decks for client use with plenty of shade.

Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 4 non-ambulatory, of which 2 may be bedridden.

Staffing, Personnel Records & Training: The facility employes 10 staff and, 1 Administrator. Staff records are kept confidential. LPA reviewed 5 staff files. Files reviewed had 1st Aid/CPR, Personnel Records/Application on file, Health screening with original TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions were on file. Administrator Certificate expires 7/30/2027. LPA reviewed staff training records, and various annual training were conducted for all staff. Continued 809-C