Facility Evaluation Report

On 12/13/2022 at 11:00 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual/Infection Control inspection. LPA observed appropriate postings on outside of front door. LPA was greeted by Staff #1 (S1) who was wearing a mask and granted access. S1 asked LPA to sign in and record temperature. Temperature taken from device on the wall. LPA observed proper Covid-19 signs posted at entry way of the facility. S1 told LPA they would call administrator Marita Amorsolo. Marita met us shortly after. LPA explained the reason for the visit. LPA reviewed the Mitigation Plan approved 02/06/2021. The inspection tool was used to complete the visit.

At 11:10 a.m. LPA began a physical plant tour of the facility and the following was observed:

Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed a 2-day perishable food and 7-day non perishable food supply. Trash bin is located in a cabinet drawer in the island to prevent cross contamination. The fire extinguisher was observed by the kitchen and was fully charged.

Dining / Living Area: The dining and living area were well lit, clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is not in use. LPA observed the thermostat at a comfortable temperature of 76°F.

Bedrooms: A fire extinguisher was observed in the hallway to the bedrooms and was fully charged. There are four (4) bedrooms designated for resident use. One (1) out of the four (4) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Auditory alarms were placed on doors due to dementia residents in care.