Facility Evaluation Report

On 10/16/2024 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with House Manager, Jet Siador and explained the purpose of the visit. LPA spoke with Administrator over the phone and they approved Jet to conduct the visit. The facility’s fire clearance was approved for 6 non-ambulatory and a hospice waiver for 2.

LPA toured facility with Jet including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/13/2023. Emergency Disaster Plan was last posted on 10/16/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2024.

At 10:50am, LPA reviewed 6 residents records. At 11:20 am, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility.