Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Raul Cruz, Caregiver and explained the purpose of today's visit. Administrator is currently out and will not be able to assist LPA. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has not submitted an Infection Control Plan.

Facility has COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

A current Plan of Operation was reviewed. The Infection Control Plan has not been added to the Plan.

A Hospice Waiver for 5 residents is approved. Liability Insurance in the amount of ($3,000,000) in total annual aggregate has expired on 3/20/2021 . Facility does not handle cash resources for the residents.

The last fire Drill was conducted on 11/19/2020. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single storey home located in a residential neighborhood. It is licensed for 6 non ambulatory, 1 of which may be bedridden. It consists of 5 resident rooms, 1 Staff bedroom/office, 3 full bathrooms, living room, family room, kitchen, dining room, attached garage and backyard. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 108.5-118.6 degrees Fahrenheit. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cameras are operational and available outside the home and living room area only. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers located in the kitchen which are both expired, and were purchased on 6/30/2022. Cleaning supplies and toxic substances are inaccessible to clients.