Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Rafael Diaz, administrator who assisted with visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly re sidents age 60 and above, approved for six (6) non-ambulatory, of which one (1) may be bedridden. Facility approved for two (2) hospice waivers. The facility cares for elderly residents with dementia. Currently, three (3) dementia residents are residing at the facility. Annual fees are current.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

The facility is located in a residential neighborhood, a single-story home and consisted of one (1) staff room, two (2) bathrooms, living room, kitchen, dining area, and indoor/outdoor activity area. Administrator certificate is current and the expiration date is 10/17/2023.

A physical tour was conducted. Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Adequate linen and personal hygiene supplies was observed. No pools and bodies of water on the premises. No firearms on the premises. Facility maintained a comfortable temperature for residents. Interior and exterior space available to permit residents to wander freely and safely.