Facility Evaluation Report

At 9:30 AM Licensing Program Analyst (LPA) Nadia Shahbazian and Licensing Program Manager (LPM) Mary Flores, conducted an unannounced annual inspection at the facility mentioned above. LPA/LPM met with the Administrator Nathaniel Hemedes and explained the reason for the visit.

The facility's total capacity is approved for six (6) non-ambulatory residents. Facility has hospice waiver for two (2) residents. The current census is five (5) residents.

At 9:45 AM, Physical tour was conducted with the Staff Janenet Maca and LPA/LPM observed the following:

Kitchen: The kitchen appliances consisted of a stove/oven, refrigerator, dishwasher and microwave oven. All appliances were observed to be functional. LPA/LPM observed enough food supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPA/LPM observed medications belonging to the administrator in the refrigerator. LPA/LPM observed a table in the kitchen with additional food supplies stored on top and underneath the kitchen table.

Common Areas : The living room and dining area is a large space, with the office space in the corner of the living room. The office area included the telephone and internet for resident use. The living room was furnished with sofas, chairs and a table and the dining room has a round table and chairs, appropriate for number of residents. The living room has a television set and a fireplace, secured with a screen. There is a freezer in the dining room, with additional food supplies. Common areas seemed cluttered and LPA/LPM observed several insects and small roaches on dining room table.