Facility Evaluation Report

On 02/25/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Health & Safety check on residents is care. LPA was greeted by Staff S1 and was allowed entry into the facility. LPA toured the facility and observed a 5 bedroom, 3 bathroom house.

LPA observed 3 out of 3 residents in care. Resident R1 was watching TV is living room and stated they were comfortable. Resident R2, who is on hospice, was sleeping in her bed. Resident 3, who is also on hospice, was in her room being fed by S1.

Facility has hospice waiver for 3. 2 out of 3 residents in care are receiving Hospice Care, LPA observed hospice care plan on file for both residents.

LPA reviewed resident and staff files and observed CPR certificate for S1. Fire extinguishers dated 08/26/21 and operating smoke detectors were observed. Current Emergency Disaster plan is posted along with other require posting.

LPA observed 2 out of 2 staff members to be present. Both have fingerprint clearances and associations to facility. Administrator on file (Staff S2) is no longer working at the facility as of 02/15/22. Current acting Administrator as of 02/24/22, is Stephanie Haro. Executive Assistant (EA) is in the process of becoming Administrator. LPA called the Administrator certification division and confirmed the application for EA was submitted on 02/01/22 and is in pending status.