Facility Evaluation Report

Licensing Program Analysts (LPA), Alviso arrived to conduct a Required -1 Year inspection, on 9/16/24 at approximately 9:30am, and met with Lead DSP Rebecca Geisner. Rebecca is also a certified ARF Administrator. Stephanie Geisner Havens, DSP/Administrator arrived to meet with the LPA. Currently there are four clients in care; All clients were at day program.

Facility is fire cleared for three (3) ambulatory and three non-ambulatory (3) clients. There are four(4) clients in care. Fire/emergency drills are being conducted as required; Last drills were held on 3/15 and 4/20 of 2024. LPAs reviewed four (4) client files. All files were complete. LPAs reviewed two (2) staff files. All files were complete.

All exits were clear and unobstructed. Hot water was checked at 116.2 degrees Fahrenheit, which is within regulation. All fire extinguishers, two(2), were serviced and tagged as required. Facility has smoke alarms and carbon monoxide detector as required. Perishable and non-perishable food was sufficient. Sufficient supply of hygiene products, paper products, and disinfectant cleaners. Sufficient supply of linens. All medications were locked up, and inaccessible to clients in care. All disinfectants/cleaners were locked up and inaccessible to clients in care. Facility was at a comfortable temperature. The facility had sufficient lighting throughout the home, in bathrooms, resident rooms, common areas, and hallways.

LPA is requesting the following forms be updated and submitted by 10/16/24.

LIC 610D - Emergency Disaster Plan, Review & Update if needed- Submit updated plan to CCL

Infection Control Plan- Review & Update if needed- Submit updated plan to CCL

LIC 400 Affidavit Regarding Client Cash Resources

No deficiencies cited during today's inspection.

Exit interview conducted with Stephanie Geisner Havens, DSP/Administrator .