Facility Evaluation Report

On 09/13/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator provided a tour of the facility inside and out.

LPA observed 2 residents in care at the time of visit. Facility is a 4 bedroom 2 bathroom home. Residents bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was 78 degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 114 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the entry way. Cleaning supplies were observed to be locked under the kitchen sink. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational. Night lights were observed in the hallways. Fire Extinguisher was observed with a service date of 06/13/23. First aid kit was observed and contained all required items. Internet devices and a working phone line were observed to be available for residents in care.

A sample of resident files were reviewed and observed to have update emergency contacts, Admission agreement, and current physician report/individual performance plans (IPP). Administrator file was also reviewed and observed to have current First Aid/CPR. Staff are fingerprinted clear and associated to the facility. (Continued on 809-C)