Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps met with Administrator Jessica Hernandez for an unannounced one (1) year Required visit for this facility.

LPA arrived at 10:00 am and was greeted by Administrator Jessica Hernandez. Eight (8) residents were observed in the living room watching TV and/or socializing at the dining room table. The rest of the residents were observed to be in their rooms watching TV and/or resting. LPA informed the Administrator of the purpose of the visit.

Infection control: LPA reviewed facility mitigation plan (approved on 03/20/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by the Administrator, and asked all infection control questions. LPA was asked to sign-in.

A tour of the physical plant was conducted with Administrator at 10:01am. The facility has five (5) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bathroom and one (1) bedroom is designated for office use only and the facility has awake staff at night. The facility is Fire Cleared for four (4) ambulatory.

LPA observed each room to have the appropriate bedding, sheets, pillowcase, mattress pad, and blankets; which are in good condition. There is a nightstand and sufficient lighting for each resident.

At 10:05 am LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 10:18am and measured within regulation at 111.4 degrees F. Continued...