Facility Evaluation Report

On 08/26/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Director Support Professional (DSP), Nicolette Taylor and explained the purpose of this visit. LPA asked that DSP Taylor call the Facility Designated Administrator (FDA) Iboni James that CCL was present. It was learned that FDA James was unable to come to the facility at this time. However, LPA met with Facility Designated Representative (FDR), Kenroy Anderson and explained the purpose of this visit. The purpose of this visit was to conduct an annual visit. There was one other staff member present, Collette Sharpe.

Current census was 3. 2 residents were observed to be in the dining room eating breakfast. 1 resident was observed to be in their room during the course of this visit. This facility is licensed to serve residents who are 18 through 59 and may be ambulatory only. This facility may also serve and retain 4I residents and vendorized by Valley Mountain Regional Center.

LPA reviewed 3 resident files. The following was observed during record review:

-R1's file has another facility on record for their ID/Emergency contact sheet, release of medical information, needs and services plan, functional capability, telecommunication, and personal rights. R1 does not have an admission agreement for this facility.

-R2's file does not have a resident signature and is incomplete for the release of medical information. This resident does not have a needs and services plan completed.

-R3's file does not have a pre-appraisal and needs and services plan conducted. This resident also does not have an IPP on file.

LPA reviewed missing information with FDR Anderson.

LPA reviewed 4 staff files. 4 out 4 staff files did not have corresponding paperwork to this facility. LPA discussed that all paperwork shall be transferred over to this facility under it's respective name, Dream Care #4. LPA was able to confirm that all staff are background cleared and have active First Aid Certificates.