Facility Evaluation Report

Licensing Program Analysts (LPAs) Alberto Lopez and Gabriela Castro conducted an unannounced Annual Required Visit. LPA met with John Michael Tanada and explained the purpose of the visit.

This facility is licensed to serve 50 Ambulatory and 30 Non-Ambulatory residents (age 60 and above). Resident rooms #1 through #19, Room #24, Room #30, and Room #38 are cleared for non-Ambulatory residents only. Facility is approved for 8 hospice residents.

LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility does have an Infection Control Plan in place.

Operational Requirements: Facility is adhering to the operational requirements.

Physical Plant & Environment Safety: LPA toured facility grounds. Carbon Monoxide detectors were tested and operable. Fire extinguishers are located throughout the building and serviced. Signal system (alert/notification goes to the nurses station). Hot water temperature measured between 121. 5 – 124.0 which is not within regulations of 105.0 – 120.0 degrees. Bathrooms have non-skid surfaces and grab bars.

Staffing : Facility is adhering to staffing requirements.