Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an annual required visit. LPA was greeted and granted access by staff #1 (S1). Staff #2 (S2) contacted the administrator Maricar Reyes and informed them LPA was at the facility. Maricar Reyes arrived at the facility and met with LPA at 11:16 a.m. LPA explained the reason for the visit. The facility has an approved fire clearance for five (5) non ambulatory and one (1) bedridden resident for a total capacity of six (6). Facility has a Hospice waiver for two (2).

At 9:52 a.m. LPA conducted a tour of the physical plant of the facility inside and out and the following was observed:

Common Areas: These include the sitting room, living room dining area. Areas were observed clean and clear of clutter. The facility maintains a comfortable temperature at 77°F. There is a fire place that was adequately screened. The carbon monoxide detector was observed by the kitchen and living room. LPA tested carbon monoxide detector at 10:00 a.m. and observed it operational. There is one fire extinguisher observed fully charged with purchase date 10/13/2023. Auditory alarm on the sliding door leading to the backyard was observed non operational.

Kitchen: The kitchen was observed clean with sufficient supply of two-day perishables and seven-day non-perishables foods; properly stored. LPA observed the knives and sharp objects located in a locked kitchen drawer inaccessible to residents in care.

Bathrooms: LPA toured three resident bathrooms. One (1) bathroom is located in a resident's bedroom for private use. All bathrooms were observed with non-skid matts, grab bars, toilet paper, paper towels and hand soap/ hand sanitizer. Hot water was tested at 10:05 a.m. and measured within regulation. (Continued to LIC809-C)