Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct an Annual Inspection. LPA was granted entry by Staff Shamraiz Arruejo. Staff contacted Administrator who responded to the facility to assist with the visit. LPA met with Administrator to conduct the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 114.2 degrees F. Facility was set at 68 F. Exterior tour conducted, all exits open and free of obstructions.

Fire extinguisher serviced on 04/19/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility did not have documentation of fire or earthquake drill. All cleaning supplies are locked in a cabinet in the laundry room. Medications were locked in a medication cabinet in the kitchen.

LPA reviewed resident records and medications and found a medication error for R1. LPA reviewed staff files and S3 is fingerprint cleared but was not transferred to the facility. LPA did not locate staff training for S3 who was the only staff at the facility upon LPA arrival. S3 did not have any of the LIC forms in S3's file.

An exit interview was conducted with Administrator and a copy of this report, appeal rights and plan of correction was provided. Civil Penalty was issued.