Facility Evaluation Report

On 11/29/2022 at 9:20 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual/Infection Control inspection. LPA was greeted by Staff #1 (S1) who was wearing a mask and granted access. LPA was asked by S1, Covid-19 screening questions and to sign in. S1 took LPA's temperature. LPA asked staff to call administrator Amy Morales. Amy met us shortly after. LPA explained the reason for the visit. LPA reviewed the Mitigation Plan approved 9/20/2021. The inspection tool was used to complete the visit.

At 9:43 a.m. LPA began a physical plant tour of the facility and following was observed:

Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. LPA observed two (2) day perishable and seven (7) day non-perishable foods. Cleaning solutions are locked under the sink. The fire extinguisher was observed in the kitchen and was last serviced on 07/05/2022.

Dining / Living Area: The dining and living area were well lit, clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is not in use. LPA observed proper Covid-19 signs posted through out the facility. LPA observed the thermostat at a comfortable temperature of 75°F

Bedrooms: There are four (4) bedrooms designated for resident use. Two (2) out of the four (4) rooms are vacant. Two (2) out of the four (4) are in use by residents. The resident rooms are furnished with required lighting, dresser, chair, bed, and linens. There was an extra supply of linens in a hallway closet.