Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with Staff Maria Angelica Ocampo DSP who allowed entry. Administrator Teodora Manohan was contacted via mobile phone and LAP discussed purpose for the visit. Administrator gave Maria authority to assist with visit. The facility is licensed for 6 residents ages 60 and over. The fire clearance is approved for six ambulatory residents of which 4 may be non-ambulatory. There is a hospice waiver approved for 1 resident.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies but did not have an Infection Control Plan at the facility during the visit.

Operational Requirements: The facility has plan to accept or retain clients with dementia. There are currently 0 bedridden residents and 4 non ambulatory resident residing at the facility. The facility did not have proof of enough liability insurance covering injury to residents and guest.

Physical Plant & Environment Safety: There are 4 resident bedrooms, 1 bedroom is shared. ! staff room with a bathroom 1 bathroom, living room, dining room, kitchen, and an attached garage. Facility has operable smoke and carbon monoxide detectors located in each room and hallway. Knives, cleaning solutions, and disinfectants are locked in the cabinets. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the bathrooms and kitchen sink. The hot water temperature in the bathroom and kitchen were measured between 111.7 – 113.1 degrees F which is between the required range of 105-120 degrees.

Staffing : There appears to be sufficient staffing at the facility. The administrator’s Teodora Manohan certificate expires 12/25/2023. Staff employed are all over the age of 18.

Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid training and no evidence of on-going training, Documents for staff indicate last training was in 2013.