Facility Evaluation Report

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPAs met with Esther Araiza. Ms. Araiza called Administrator to inform of LPA visit. Administrator was not available at the time but requested Julie Hunter to help during visit. The purpose of today’s visit was explained to facility personnel met during this visit. Administrator Facility is licensed to serve six (6) non-ambulatory residents aged 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 4 residents. Administrator. Administrator arrived and participated in visit.

The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows:

· Three (4) resident bedrooms, two (2) Full Bathroom, attached car garage, shaded outdoor area, living room, kitchen, and dining room, and front and back yard.

· Resident Admission Agreements, Residents & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Consumer Needs and Service Plan.

· LPA reviewed three (5) staff files and four (5) Resident files.

Interview was conducted with two (2) staff and one (1) Resident. Other residents were sleeping or unable to respond to questions.