Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso is conducting an Required-1 Year inspection, on 9/30/24 at approximately 9:15am, and met with caregiver Alma Gonzalez. Administrator Lindsey Gregorio arrived at the facility to meet with the LPA.

There are two (2) clients residing in the home; Clients were at day program during the inspection. Facility has an approved fire clearance for six (6) ambulatory. The facility will be using the four client rooms as private bedrooms. The facility does have a required infection control plan.

The LPA reviewed two (2) resident files. Files had required documents. Client P&I funds were maintained as required, and was observed to not mixed with facility petty cash and/or any other funds.

The LPA reviewed five(5) staff files. All staff have required criminal record clearance. All staff have required training. All staff have first aid and cpr certification.

Facility had a sufficient food supply. Sufficient cleaners/disinfectants, paper products, hygiene products, and linens. Facility had a sufficient supply of furnishings for client use. The facility was observed to be at a comfortable temperature. Sufficient lighting in hallways, bathrooms, resident rooms, and common areas. Hot water was checked at 114.6 degrees Fahrenheit, which is within regulation.

LPA is requesting the following documents be updated and submitted by 10/30/2024:

LIC308 - Designation of Administrator Responsibility

Infection Control Plan (review& update if needed-if updated submit a copy-if no changes-

Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash)

Copy of Surety bond-send sufficient coverage per form

Copy of current Administrator Certificate