Facility Evaluation Report

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Caregiver Jose Rodriguez and explained the reason for the visit. The administrator Yamilex Razo arrived shortly after. The facility is licensed to serve six non-ambulatory residents ages 60 years and above and approved for four hospice waivers. Facility currently has 5 non-ambulatory and 1 ambulatory resident. The facility is located in a residential area. A tour of the single-story facility included: living room, family room, kitchen, dining area, 5 resident bedrooms, 2 bathrooms, front yard, backyard and attached garage.

LPA and Jose Rodriguez toured the facility and the following was observed: Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 113.9 degrees F and 116.5 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen in each resident bedroom’s closet and clean towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There are two carbon monoxides in the hallways and are properly operating. There is a fire extinguisher in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps, cleaning supplies and toxins are kept locked in a kitchen cabinet and are inaccessible to residents. First Aid kit was fully stocked with current manual and it is kept in the medication cabinet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction.