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 Joann Hernandez, Caregiver and explained the reason for the visit. Max Raharuhi, Administrator Assistant 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 were four (4) residents under hospice care during inspection and two (2) residents receiving home health.

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

The facility is in a residential area and is a one-story home consisting of six (6) resident bedrooms, two (2) restrooms with one being a private restroom, living room/dining area, kitchen, laundry room, garage, front yard, and backyard w/a gated pool. LPA observed six (6) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting).