Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspec tion. LPA was met by Rachel De Chavez, Assistant Administrator and explained the purpose of today's visit. T here are currently 81 elderly residents 60 years and older residing in the facility. Only one (1) resident is receiving hospice care and currently, no bedridden residents. At 2:10pm, the Administrator, Susan Park arrived and assisted LPA with the inspection.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility and LPA was screened upon entry. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Facility has COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Operational Requirements : A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility has a Dementia waiver in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 12/05/2023. Surety Bond is valid and in place. The last fire Drill was conducted on 07/23/2023. C are and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: The facility is a single storey building located in a residential neighborhood consisting of 98 rooms, some of which are being used as model rooms, administration offices and storage rooms. There is one (1) large activity room/living room, across the activity room is a separate area for library, bingo activity area, pool table, computer room and a room designated for arts and crafts. It has a large dining room, laundry room, nurse's station, medication room and a basement parking. It is licensed to care for 120 non ambulatory elderly residents with a hospice waiver for ten (10). Current census is (81) elderly residents. The facility has Dementia residents. The main entrance/lobby area is used as the central entry point for everyone. A check-in station is set up at the front desk and Covid-19 symptom screening is initiated at entry, where LPA was screened. COVID-19 Infection Control screening protocols and supplies included a thermometer, PPE supplies, screening logs, and sign-in sheet were observed in the main lobby. COVID-19 signage was posted around the building. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has twenty six (26) fully charged fire extinguishers which were last inspected on 02/24/2023. Assistant Administrator stated that the local fire department conducted an annual inspection of the facility in February 2023. The facility has a fire suppression system which did not run properly during that time, which required a 2nd inspection on 8/14/2023. During the last fire marshal's visit, the fire suppression system worked and ran smoothly. Facility is currently awaiting for their fire clearance. Cleaning supplies and toxic substances are inaccessible to residents. Hot water temperature readings measured within the required 105-120 degrees Fahrenheit. The following random resident rooms were inspected and the water readings are as follows: Room #1 (113.9 deg F), Room #7 (112.4 deg F), Room #18 (112.7 deg F), Room #33 (108.5 deg F), Room #47 (107.4 deg F), Room #52 (116.2 deg F), Room #67 (105.6 deg F), Room #69 (105.9 deg F),