Facility Evaluation Report

On 4/28/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. House Manager, Mary Ortiz arrived shortly after to assist with today’s visit.

LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:30 PM and the following was noted:

The facility is a single-story building with five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver for four (4). Sign in sheet, hand sanitizer, gloves and masks are available upon entrance.

Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 71°F. LPA observed a fire extinguisher to be located in the kitchen and dated 07/20/24. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights alongside the hallway leading towards the kitchen. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed.

Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. LPA observed an additional refrigerator used to store extra food located inside the garage. Knives/sharps were observed to be kept in a locked kitchen cabinet. The cleaning solutions/toxins were observed to be kept locked in the garage. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C)