Facility Evaluation Report

On 2/04/2025 at approximately 09:40 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by Administrator Suzette Tamayo. LPA stated the reason for their visit.

LPA asked for census, Staff/Resident Roster, and Insurance. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. There is no designated staff room. The facility has approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for one (1). Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

Common areas: Living room and dining room observed to be neat, clean, and organized. Both rooms observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. Fire extinguishe r located in the kitchen and dated 07/30/24. Required postings such as See/Say Something, Long-Term Ombudsman, and Resident’s Rights are located aside the dining room. Fireplace: Observed to be covered and inaccessible to residents. Working telephone observed.

Kitchen: Kitchen observed to be clean and inaccessible to pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. Knives and sharps observed to be locked in bottom kitchen cabinet. Kitchen appliances observed to be working and in proper condition. (continued on LIC 809-C)