Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an unannounced annual required visit. LPA rang the door bell and was contacted by the administrator. LPA explained the reason for the visit. Administrator stated they were out in the community running errands and well meet LPA at the facility. LPA was greeted and granted access by staff #1(S1).

At approximately 10:20 am., LPA initiated the physical plant tour of the facility inside and out. The following was observed. LPA observed a sign in log for visitors by the entrance and required postings on a bulletin board by the dining table.

Kitchen: LPA conducted a tour of the kitchen at 10:25 a.m, and observed there to be sufficient amount of two-day perishables and seven-day non-perishables food. LPA also observed a deep freezer. Food storage and preparation areas were clear of clutter. LPA observed all knives and sharps locked and inaccessible to residents in care. The Medication cabinet was in the kitchen and was observed to be locked. LPA observed a fire extinguisher by the kitchen to be fully charged.

Bedrooms: There are three (3) bedrooms for residents' use. Bedrooms may be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient lighting. LPA observed extra linens in residents' closets.

Bathrooms: There are two (2) bathrooms for residents. One (1) bathroom is located in a shared bedroom for private use. Bathrooms were properly supplied with toilet paper, paper towels, hand soap, nonskid matts and grab bars. Hot water temperature was measured at 10:45 a.m., and read 116.2 degrees Fahrenheit.