Facility Evaluation Report

Licensing Program Analyst (LPA) Lorena Casillas and Evelin Rios conducted an unannounced visit and were greeted by staff #1 (S1). LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there are four residents living at the facility. The facility is licensed for four residents of which four are ambulatory.

Staff called the Administrator and the Administrator arrived at 10:15 am.

LPAs toured the facility at 8:45am until 10:00 am

Common Areas – LPAs observed the living room contained seating. The dining room contained dining room table and chairs.

Kitchen – LPAs observed the knives were locked in a kitchen cabinet. The medications and first aid kit were locked in a kitchen cabinet. LPAs observed a two-day supply of perishable foods and a seven day supply of non-perishable foods.

Resident Bedrooms - There are four resident bedrooms which are furnished with a bed, linens, nightstand, chest of drawers and a closet.

Bathroom - There are two bathrooms located in the facility. LPA Rios tested the water temperature in two of two bathrooms at 11:05am in which temperatures were between 105 degrees F and 120.0 degrees F. Both bathrooms contained hand soap, paper towels, trash can, and grab bars. One out of two bathrooms did not contain slip resistant mat in the shower. S1 states that resident that uses that shower does not like shower mats and removes them. Administrator purchased a shower mat during visit.