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25 | Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA Maldonado met with Day Program Supervisor, Paula Panduro. Program Director, Cecilia Pantaleon arrived shortly after and assisted with the visit.
During today's visit, LPA Maldonado conducted a tour of the physical plant with Supervisor, observed the facility food supplies, reviewed (5) client files, (5) staff files, and conducted interviews with (5) staff, and (5) clients. The facility is a single story building operating as an Adult Day Program. It is licensed to serve (45) Developmentally Disabled adults, ages 18-65. There is a fire clearance approved for (10) non-ambulatory clients. Hours of operation are M-F 8:30am to 2:30pm. An Infection Control plan has been submitted to the department for review.
The building consists of an open floor plan for activities, staff break room, changing room to accommodate incontinent clients, (7) separate activity rooms, storage closets/rooms, relaxation room equipped with a bed and clean linens, men's bathroom with individual stalls, women's bathroom with individual stalls, (3) offices, conference room, male and female locker room for personal storage, kitchen, and fitness room. Activities appropriate to clients are offered/provided. Sufficient staff was observed and were supervising clients at all times. Facility was clean and free of hazards. Bathrooms were observed to have the required grab bars. The hot water was tested and measured between 105*F-113*F. Clients provide their own lunch and snacks. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to clients in care. Smoke/Carbon monoxide detectors were observed in every room and operational. The last emergency drill conducted was 3/15/24. Emergency food supplies/water were observed and available for clients in care. A current first aid manual was available as required. First aid kit was inspected and observed to have the required items. No bodies of water were observed on the premises. (5) Client files and (5) staff files were reviewed and observed to be complete with all required documentation. There no clients currently storing medications or assisted with medications during program hours.
No deficiencies were observed or cited, during today's visit.
An exit interview was conducted and a copy of this report was provided. |