Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Annual Inspection. Upon arrival LPA was greeted by staff #1(S1) and granted access. S1 contacted the administrator to inform them LPA was at the facility. Administrator, Natividad Arayata and administrator designee Marti Arayata met LPA shortly after. LPA explained the purpose of the visit. The facility has an approved fire clearance for six (6) non ambulatory residents of which one (1) may be bedridden in bedroom #1. Facility has a hospice waiver for four (4).

At 10:00 am, LPA conducted a physical plant tour of the facility an observed the following.

Bedrooms: There are five (5) total resident bedrooms and one (1) is shared. All bedrooms have the proper furniture and adequate lighting. The auditory alarms on each exit door was tested and found to be operational. When LPA tried to access bedroom #2 the Administrator designee had to unlock the bedroom door. The bedroom is currently vacant. Inside LPA observed an exiting door with a bent screw or bolt holding it closed. Screw was removed and LPA was able to open it to test auditory alarm. LPA observed the same holes where a screw is placed to keep the door closed by the front door of the facility. LPA discussed the observation with the administrator. Administrator explained they understood it was against regulation, but they have been having an issue with resident #1(R1) constantly trying to leave the facility without supervision. The screw is used to keep resident #1(R1) from leaving when staff cannot accompany them or convince them to stay. R1 confirmed they are not able to leave through the front door because something is preventing the door from opening. Administrator stated they would not be obstructing the door moving forward and will discuss this with there staff.

Bathrooms: There are three (3) bathrooms and one (1) is inside the shared bedroom for private use. Each bathroom is equipped with grab bars and non-slip mats. The hot water temperature was taken at 11:00 a.m. from one (1) bathroom and read 113 degrees Fahrenheit within regulation. (Continued. to LIC809-C)