Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the required annual inspection. LPA arrived unannounced and met with CNA Emani Lawrence and explained the purpose of today’s visit. Administrator Cheryl Dallas arrived shortly. Facility is licensed to serve six (6) non-ambulatory residents, of which one (1) bedridden, ages 60 and over. Three (3) hospice waivers on file. The facility is single story house located in a residential neighborhood in the city of Lakewood. LPA toured the facilities physical plant, indoor and outdoor. The facility has five (5) resident bedrooms, three (3) bathrooms, living room, dining room, kitchen, laundry room/office, and garage used for storage. Bedroom #5 is approved for bedridden

LPA toured the facility and observed the following: All resident bedrooms have the required furniture and bedding. There is extra clean linen and towels in hallway cabinets. Smoke detectors/carbon monoxide detectors were observed throughout facility. The facility has three (3) fire extinguisher which are kept in kitchen, hallway and office and are fully charged. Cleaning supplies and toxic substances are inaccessible locked in cupboards in kitchen cabinet and laundry room. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. LPA did not observe a sufficient supply of 2 days perishable foods Administrator had food purchased at time of visit. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. Bathroom #2 had a reading of 102.5 degrees. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents located in backyard. LPA observed paint and other objects on side of house. During tour of backyard a combination lock was observed on perimeter fence without waiver from this licensing agency, no approval from on fire clearance inspection sheet. Lock was removed at time of visit. SEE LIC 809 C