Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/03/2023 at 1:30pm. LPA was met by John Michael Tanada and explained the purpose of the visit. Facility is licensed to serve 50 Ambulatory and 30 Non-Ambulatory residents (age 60 and above). LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), copy of Liability Insurance and 3 resident Medication Administration Record (MAR). Resident rooms #1 thru #19, Room #24, Room #30, and Room #38 are cleared for non-Ambulatory residents only. Facility is approved for 8 hospice residents.

LPA OBSERVATIONS: Tour was given by Administrator Tanada at 1:45 pm. Kitchen, pantry, laundry room, centrally stored medications room, 4 randomly selected resident rooms (Room# 14, 16, 23, and 27), Shower room # 4, Visitor bathroom, patio area, and TV/Day room were inspected.

· TV/Day Room: Was clean and had sufficient seating for residents and visitors.

· Kitchen/Pantry: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7 days of non-perishables. Kitchen sink water temperature was measured at 106.0 degrees F. Signs promoting hand washing and social distancing were observed.

· Dining Room: Dining room area was clean; chairs were spaced out to promote social distancing. Signs promoting social distancing and cough/sneeze etiquette were not observed throughout dining area. LPA will issue Technical Advisory.

· Laundry Room: Was secured an inaccessible to residents. Room was observed to be clean and organized. LPA observed sufficient linen and towels.