Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct and unannounced annual required visit. LPA rang the door bell and was greeted by the Licensee. Licensee granted access. LPA informed Licensee the purpose of the visit. This is an Residential Care Facility for the Elderly (RCFE), with an approved fire clearance for (6) non-ambulatory residents of which one (1) can be bedridden for a total capacity of six (6). The facility is a single story building with six (6) bedrooms and three (3) bathrooms.

At approximately 9:20 a.m., LPA conducted a physical plant tour of the facility, both inside and outside, and observed the following:

There is only one entrance being utilized at the facility. At the entrance LPA observed a visitor sign-in log and hand sanitizer. LPA observed required postings through out the facility.

Common areas were observed clean and surfaces were clear of clutter. The dining area was observed with a table and chairs that sit the capacity of the facility. The living room was observed to be properly furnished with couches and recliner. The fireplace was observed not in use and covered with a screen inaccessible to residents.

The kitchen was observed to have a sufficient amount of (2) days perishable and seven (7) days non-perishable food. Kitchen area was observed clean and free of pests. Knives and sharps were observed to be locked in a kitchen drawer inaccessible to residents. Kitchen appliances, the refrigerator, stove, dishwasher and microwave were observed functioning properly. The fire extinguisher located by the the kitchen was fully charged. (Continued on LIC 809-C)