Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Escarling Godoy Manager and explained the reason for the visit.

The facility is licensed to serve fifteen (15) non-ambulatory residents, ages 60 and above, and had six (6) Hospice Waiver approved. Facility is a single home located in a residential neighborhood. It consist of a lobby area, office, a kitchen, a family room, a dining room, 10 resident rooms, 5 resident bathrooms, 1 staff bathroom, a garage, a laundry area, a front porch, a back yard.

LPA reviewed the following CARE inspection tool domains during this visit:

Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed.

Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license.

Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Escarling Godoy and observed the following: Facility was observed in good repair indoors and outdoors. All common areas are clean, and providing sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a box. Medications were observed locked in the office. Cleaning supplies were observed inaccessible to residents in the garage. Laundry area was observed in good repair. LPA observed 5 random resident rooms, each in good repair, with all bedding supplies, and sufficient lighting. Five bathrooms were observed all in good repair, with grab bars, and non-slip shower floors. (CONTINUED ON LIC 809C)