Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Elba Rodriguez and explained reason for visit.

Facility is licensed to serve six (6) non-ambulatory residents age 60 and over. The facility may retain three (3) hospice residents. During record review it was revealed that two (2) residents are bedridden. Facility will contact fire department. The facility is in a residential area. A tour of the facility included the living room, kitchen with dining area, 4 resident bedrooms, 2 bathrooms, attached garage, and outside shaded area for residents.

LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. LPA observed four residents with bed rails and no physicians’ orders. The Smoke /carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has three (3) fully charged fire extinguishers throughout facility. Cleaning supplies and toxic substances were observed to be inaccessible. During the tour LPA observed a large knife in drying rack on kitchen counter accessible to residents. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. 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 outside. Passageways and exits are free of obstruction.

LPA reviewed two staff files that both were missing required training. Administrator file was not available during visit.

***Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection. ***

Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Elba Rodriguez