Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced Annual Required Visit at approximately 8:07 AM. LPA was met by Care giver Stephanie Mariano and explained the purpose of the visit. Administrator Leah Ignacio arrived shortly. Facility is licensed to serve residents over 60 years old six (6) can be non-ambulatory, of which one zero (0) can be on hospice. It was observed that facility has one resident receiving hospice care without a waiver from department. Deficiency has been cited.The facility is a single-story home, located in a residential area. The home consists of a living room, (3) residents’ bedrooms, (1) live-in staff room, (1) room designated for licensee with (1) full bathroom inside the room, (1) resident bathroom, a kitchen, pantry, dining room, living room, detached garage, and shaded patio with seating in the backyard.

LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. Bedroom one (B1) is a shared room and it was observed to have a camera on dresser of resident (R2). Bedroom four (B4) was observed to have full bed rails without physicians’ orders. There is extra clean linen and towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is 1 carbon monoxide in the hallway and is properly operating. The facility has one (1) fully charged fire extinguisher which is kept in the kitchen. Cleaning supplies and toxic substances were observed to be inaccessible to clients in kitchen pantry. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. It was observed that facility did not have a sufficient supply of 2 days perishable & 7 days non-perishable food deficiency cited. Sharps are locked and placed in cabinet in kitchen. During tour of facility, it was observed that resident R1 was walking around unsupervised with scissors. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. LPA observed a hospital bed and mattress against wall next to shaded patio deficiency cited. The garage is clean and has extra supplies.