Facility Evaluation Report

Licensing Program Analysts (LPAs) Sandra Urena and Erica Mosley arrived at the facility unannounced at 11:53 a.m. to conduct a required annual inspection. The LPAs were greeted by staff and informed them of the reason for the visit. Administrator arrived about 30 minutes later.

The LPAs and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 71 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last serviced on 01/09/2024. The LPAs observed required postings throughout the common space. The LPAs noticed that the Emergency Disaster Plan LIC 610E(Assignments) staff’s names need to be updated as some staff are no longer employed at the facility.

KITCHEN: Knives are locked in a kitchen drawer stored inaccessible to residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 113.0 degrees Fahrenheit. During the inspection at 12:41 p.m., the LPAs observed the bottom sink cabinet which contained the chemicals to be unlocked and chemicals accessible to residents in care. The cabinet was secured during the visit.

BEDROOMS: There are (6) resident bedrooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. At the time of the visit two bedrooms’ (Bedroom #2 and #3) exit door were obstructed by furniture. The furniture was removed during the visit. The LPAs observed and detected the smell of urine in bedroom #5, staff were instructed to change the bed linens.

There was a linen closet in the hallway with extra towels and linens.