Facility Evaluation Report

Licensing Program Analyst (LPA) Sanjay Vaid and Elena Mallett conducted required annual inspection. LPA met with Caregiver Nicholas Loterena and was allowed entry into the facility discussed purpose of today’s visit. Rowena Santos Licensee arrived shortly after. This facility is licensed to serve six (6) non-ambulatory of which one (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There are three (3) residents under hospice care currently.

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

Physical Plant and Environment safety: LPA Vaid and Mallett observed the following: disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. Carbon monoxide detectors and smoke alarms in hallways. Inspected five (5) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. Observed postings encouraging proper handwashing etiquette in restrooms. Observed grab bars near toilets and inside showers. LPA’s observed no-slip mat in showers. Showers were observed to be wheelchair accessible.

Food Service: LPAs Vaid and Mallett observed sufficient supply of non-perishable for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean. Continued on 809C............