Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Glenda Precillas and explained the reason for the visit. Licensee arrived shortly after.

The facility is licensed to serve 6 residents age 60 and over of which 6 may be non-ambulatory with a hospice waiver for 6. The facility is located in a residential area and consist of a single home with (4) resident bedrooms, (3) bathrooms, a living room, a dining room, a kitchen, a family room, an attached garage/laundry, a front yard, and a back yard.

The following domains were reviewed during this visit:

Infection Control : Facility maintains a copy of the infection control plan. Staff #2-4's medical assessments did not have results for TB test.

Operational Requirements: Facility maintains a plan of operation, fire clearance. Facility is operating within the limitations of their license. They currently don't any residents under hospice care, or bedridden. A current liability insurance was observed and a copy was obtained.

Physical Plant/Environmental Safety: LPA toured the facility with Glenda Precillas and observed the following. Facility was observed clean and in good repair. Living room, dining room, and family room were observed with furniture in good repair. Living room has a covered fireplace. Kitchen was observed clean. Cleaning supplies and sharps are maintained locked under the sink. Refrigerator/freezer and pantry were observed. Medication cabinet is located in family room. Four (4) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Half bed rails were observed in residents' beds and physician's orders were on each residents' file. Three (3) bathrooms were observed in good repair and clean