Facility Evaluation Report

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Carina Demman. The following 12 (CARE) tool domains were utilized during the inspection:

Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. Infection Control Plan observed.

A fire clearance for 6 residents of which (6) may be non ambulatory

Hospice care waiver approved for one (1) resident.

Facility is a single story home consisting of 7 bedrooms (5 resident rooms & 2 staff rooms), 3 bathrooms, living room, family room, dining room, kitchen, laundry room, backyard with shaded patio furniture, and an attached garage

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. Cleaning supplies and toxic substances are inaccessible.

Water temperature readings measured within the required 105 - 120 degrees Fahrenheit.

A total of (4) staff members provide supervision to the residents.