Facility Evaluation Report

Licensing Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent unannounced Required 1-year annual continuation visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Fedelito Ruiz, administrator for the facility, and explained the purpose of the visit. There are six residents residing within the home.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

· Infection control practices were observed.

· The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, six (6) of which may be non-ambulatory, five (5) of which may be bedridden, and a hospice waiver approved for one (1) resident. The facility consists of a kitchen and dining room, a living room, an office area, three (3) restrooms, six (6) bedrooms, and a backyard area that contains a shaded area. The facility was observed to be in good repair.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has two (2) fully charged fire extinguishers in the facility.

· Water temperature readings for one of the bathrooms in the home did not fall within the required range of 105 - 120 degrees Fahrenheit.