Facility Evaluation Report

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff Joel Ros. Administrator Iwona Kaya arrived later.

The following was observed during the inspection:

Infection Control: The facility has an Infection Control Plan that is reviewed annually.

Operational Requirements: A Dementia and hospice waiver for 4 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate expires 3/8/2027

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents. The facility consists of a kitchen, dining room, family room, living room, one live-in staff bedroom, four (4) resident bedrooms, laundry room, and detached garage. The facility has a fire extinguisher. Rooms are equipped with required furniture and bedding. Cleaning supplies and toxic substances are inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted.

"Smoke and carbon monoxide detectors were tested. Room #1's smoke detector is not properly installed and was observed hanging by wires.