Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an annual inspection visit. LPA met with Lourdes Bisnar and discussed the purpose of today’s visit.

This facility consists of (4) resident bedrooms, (2) bathrooms (one in bedroom #1), a living room, dining room, kitchen and attached garage. This facility is approved for (5) non-ambulatory and (1) bedridden resident (bedroom #4). This facility is also approved for (6) hospice residents.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools observed the following:

Infection Control: Facility has an Infection Control Policy in place and was observed to be posted.

Operational Requirements: Facility is adhering to the operational requirements.

Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detectors (near the dining area) observed. The fire extinguisher is located in the kitchen and was last serviced on 08/14/24. Last drill was conducted on 12/08/24. Bathrooms have non-skid surfaces and grab bars.

Staffing : Facility is adhering to staffing requirements.

Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed staff files for S-1 through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file.

**Refer to LIC 809C for the continuation of this report.**