Facility Evaluation Report

An unannounced Required One (1) Year visit to this facility is conducted today by Licensing Program Analysts (LPA) Jose Tan. LPA met with the Administrator Rita Noravian and explained the reason for the visit. Facility fire cleared for a capacity of 186 ambulatory, 118 of which may be non-ambulatory and hospice waiver for one (1) resident. There is currently no resident receiving hospice care services.

There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. The facility has an approved mitigation and infection control plan on file.

LPA conducted physical plant tour of the facility with the Administrator at 9:18 AM. Facility currently has 38 residents on the Assisted Living Waiver (ALW) program. The facility is a three (3) storey building. Residents' bedrooms on the first, second and third floors were inspected. Common areas, including the activity rooms, meeting rooms, dining rooms and a gym appeared clean and were properly furnished. The kitchen was clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at appropriate temperature. There was a sufficient amount of perishable and non-perishable food at the facility and properly stored. Residents do not have access to the kitchen; dangerous items are locked. The facility menu appears to meet the daily dietary needs for residents. There were no pesticides or poisons observed near any food areas. Entry/exits were free of obstruction. The outdoor area was clean and free of hazards. The patios and balconies have proper furnishings. The medications were locked in the medication room, properly labeled and stored. Medication documentation and implementation appeared to be complete and updated. Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. (continued on LIC 809-C)