Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps met with administrator Maricar Reyes for an unannounced one (1) year Required visit for this facility.

LPA arrived at 10:40 am and was greeted by caregiver Rudy Abrenica. One (1) resident was observed in the kitchen eating. The rest of the residents were observed to be in their room sleeping, watching TV and/or resting. The Administrator arrived at 12:00 pm. LPA informed the Administrator of the purpose of the visit.

Infection control: LPA was unable to review the facility mitigation plan since there was no file found. LPA requested the mitigation plan to ensure the facility is following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitizer was available.

A tour of the physical plant was conducted with the caregiver at 11:40am. The facility has six (6) bedrooms and three (3) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for five (5) non-ambulatory, one (1) bedridden in room two (2), and a hospice waiver for two (2). The facility currently has one resident on hospice and one bedridden resident.

LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 76°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:55 am. There are two (2) fire extinguishers, one (1) is located in the kitchen and one (1) is located in the bedroom hallway. Fire extinguishers were observed to be full and last serviced on 06/02/21.