Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 09/16/2023. LPA was met by Staff #1 (S1) and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents and is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has dementia care for residents and an approved hospice waiver for two (2) residents. The facility has secured perimeters in the form of a motorized gate in the front to prevent residents from leaving the property.

LPA OBSERVATIONS: Tour began at 10:10 am and was led by S1. The facility is a single-story building located in a residential neighborhood with five (5) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in garage, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in garage area to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 119.7 degrees F. Kitchen appliances were observed to be clean and in working order.

Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed fully charged fire extinguisher in this area. LPA Ramirez observed three (3) out of five (5) residents in care sitting and resting in living room during visit.

Linen Closet: Contained plenty linens, towels, and hygiene products.