Facility Evaluation Report

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Eva Tancinco and explained the reason for the visit. Ana Stark Pleitez, Administrator arrived shortly thereafter.

The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility is approved to retain no more than four (4) residents receiving hospice care.

There was one (1) residents under hospice care during inspection.

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. “Oxygen in Use / No Smoking” signs were not observed throughout the facility. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

The facility is located in a residential area and is a one-story home consisting of six (6) resident bedrooms and four (4) restrooms, including two private resident restrooms, one guest restroom, and one caregiver restroom. The facility also includes a living room, kitchen, dining area, garage with an extra washer and dryer, front yard, and backyard. The property includes caregiver corridors located within and near the garage area. LPA observed all six (6) resident bedrooms and verified that each contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Cleaning supplies and toxic substances were observed to be inaccessible to residents and stored in a locked kitchen cabinet beneath the sink and in a hallway closet. Bathrooms were observed to be clean and equipped with required grab bars near toilets and inside showers, as well as non-skid mats. During the visit, the hot water temperature measured above 140°F, which exceeds the required range of 105°F–120°F. A citation will be issued. Extra linens and towels were observed to be available in a hallway cabinet. (continued on 809C)