Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a continued annual inspection, on 11/06/24 at approximately 9:45am, and met with caregiver Marylis Gachu.

All clients were at day program during the inspection. Facility has two (2) client bedrooms. Facility has a fire clearance for three (3) ambulatory clients, and one (1) non-ambulatory client.

LPA reviewed three (3) client files. Medications were reviewed. LPA reviewed four (4) staff files. LPA conducted annual visit on 10/22/24, and cited a deficiency for two (2) staff (S1 & S2) not being associated to the facility as required, Criminal Record Clearance 80019(e)(3)(4), see LIC809D of 10/22/24. The civil penalty for this citation is being assessed today, in the amount of $200, see LIC421BG.

Facility hot water was 120. degrees Fahrenheit. LPA discussed during the inspection, regulation requirement of hot water, it is not to be over 120. degrees or under 105. degrees Fahrenheit. The facility had a sufficient supply of perishable and non-perishable food during the inspection. All smoke alarms were working appropriately during the inspection. All fire extinguishers were serviced and tagged as required.

LPA requested the following forms to be updated and submitted to CCL by 12/6/24:

Affidavit Regarding Client Cash Resources

Emergency Disaster Plan (review-if changes, submit to CCL)

Infection Control Plan (review-if changes, submit to CCL)

The following observed deficiencies will be cited:

Per LPA interview with staff, and LPA observations, the keys to the medication cabinet are kept in a drawer of a small plastic storage container that is kept on the kitchen counter. LPA obtained pictures. This allows the medication keys to be accessible to clients and all others when the keys are in it; Only staff trained to assist clients with medications, should have access to the medications. LPA obtained photos. Deficiency will be cited, Health Related Services 80075(k)(1)-Centrally stored medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication, see LIC809D.