Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 02:35 PM. LPA met with facility staff who contacted the facility Administrator Selva Banos via telephone call. The Administrator arrived to the facility at 02:46 PM Entrance interview conducted and the reason for the visit was explained.

Beginning at 02:47 PM, the LPA, along with the Administrator and facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS : There are four (4) bedrooms in the facility; three (3) are designated for resident use and one (1) is designated as a staff room. Two (2) resident bedrooms are private rooms, and one (1) resident bedroom is a shared room. LPA and the Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

BATHROOMS : There are two (2) bathrooms at the facility. Both are designated as shared/common resident bathrooms. Both bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. The water temperature was measured in both bathrooms to be between 117.0 degrees Fahrenheit and 119.1 degrees Fahrenheit which is in compliance with regulation. One (1) bathroom was observed to contain a locked under sink cabinet which contained cleaning chemicals and grooming supplies.

COMMON AREAS : This included the living room, dining room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. LPA observed the living room to contain the facility’s telephone, couches, and activities for resident use. The dining room was observed to be clean and contained adequate seating for resident use. Continued on LIC 809C.