Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Tokie Ayabe at approximately 8:00AM and explained reason for visit. This facility is a Residential Care for Elderly (RCFE). Facility is licensed to serve six (6) non-ambulatory elderly residents, ages 60 and above in rooms A, C, and D. One (1) bedridden is approved in room B. Hospice waiver approved for five (5) residents. Annual licensing fees are current. The facility was a two-story building. First floor had five (5) resident rooms, living room, kitchen, dining area and four (4) resident bathrooms. Second floor consisted of four (4) staff rooms and two (2) staff bathrooms. Administrator will submit updated facility sketch for bedroom E. Administrator did not have a plan of operation and a dementia plan available at time of visit.

All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Administrator will obtain physicians orders for all resident bed rails. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen. LPA observed cleaning supplies and toxic substances under bathroom #1 sink and in unlocked hallway closet. LPA observed two pairs of scissors in two kitchen drawers at time of visit. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. There is a shaded seating area in backyard.