Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/11/2023 at 12:25 pm. LPA was met by Staff #1 (S1) and explained the purpose of the visit. At 12:42 pm Administrator Toby Miclat later arrived to assist in tour. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for four (4) hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), and Administrator Miclat will submit copy of liability insurance.

LPA OBSERVATIONS: Tour began at at 12:45 pm and was led by Administrator Miclat. The Facility is a single story building in a residential area with six (6) resident bedrooms, dining room, four (4) bathrooms, kitchen, laundry room/pantry and attached car garage.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen/Pantry: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7 days of non-perishables. Kitchen sink water temperature was measured at 114.3 degrees F. Signs promoting hand washing were observed. Sharps were secured in cabinet to the right of refrigerator and inaccessible to residents. Cleaning solutions and disinfectants were observed to be locked in cabinet directly under kitchen sink and inaccessible to residents. Pantry contained emergency water supply and emergency food supply. Extra PPE was observed to be stored in kitchen cabinet near sink.

· Dining Room/Family Room/TV Room: Dining room was observed to be clean and contained table and chairs. Signs promoting social distancing and cough/sneeze etiquette were observed throughout this area.