Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to caregiver Mariesol Gomez. There are currently 5 Dementia residents 60 years and older residing in the facility. Two (2) residents receives home health, and none are receiving hospice services. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were utilized during the inspection.

Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility has an Infection Control Plan and COVID-19 Mitigation Plan.

A current Plan of Operation was reviewed.

The facility has a Dementia Waiver in place. A Hospice Waiver for 4 is approved.

A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 3 only.

Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current and expires 4/9/2024.

A surety bond is not applicable. Facility does not handle resident's money.

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