Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required-1 year inspection. LPA was allowed entry by Jaime Patena, Caregiver and Perseveranda Ramos and explained the purpose of today's visit. Administrators, Thomas Trice and Liza Trice arrived at 10am and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 09/01/2024. Administrator Thomas Trice stated that facility does not handle cash resources for the residents. The last fire drill was conducted on 12/07/2023. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulato ry residents ages 60 and over. Facility has hospice waiver approved for 2. Current census is six (6) non ambulatory. Home consists of five (5) resident bedrooms, one (1) staff bedroom, (4) bathrooms, living room, dining room, family room, kitchen, backyard, and a detached garage. The interior and exterior physic al plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. LPA observed broken flooring supplies, trash and other miscellaneous items in the side yard. Smoke and carbon monoxide detectors are operational. LPA observed the fireplace in the living room was not adequately screened. One (1) fire extinguisher located in the kitchen entrance was serviced on 12/08/2023. Administrator stated that the laundry dryer is broken, but have already contacted a service technician to fix it. Service technician is scheduled to come in today, 12/09/2023 or tomorrow, 12/10/2023. All bathrooms toured were observed to be fully stocked with hand soap, and paper towels, and had the required grab bars and nonskid mats in place. All showers in bathrooms accommodate non-ambulatory clients. At 10:15am, hot water temperature readings were measured which are within the required 105-120 degrees Fahrenheit. Medication was observed to be centrally stored in the kitchen cabinet. ***CONTINUED ON LIC 809-C**