Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth and Lorena Casillas conducted an unannounced visit and was greeted by the two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there are two residents living at the facility. The facility is licensed for five residents of which are three non-ambulatory and two ambulatory residents..

Staff called the Administrator and the Administrator arrived at 9:20 am.

LPAs toured the facility with the Administrator at 9:30 am until 10:30 am

Common Areas – LPA observed the living room contained seating. The dining room contained dining room table and chairs..

Kitchen – LPAs observed the knives were locked in a kitchen cabinet. The medications and first aid kit were locked in a kitchen cabinet. LPAs observed a two-day supply of perishable foods and a seven day supply of non-perishable foods. When observing the refrigerator content, LPAs observed food containers which did not contain lids.

Resident Bedrooms - There are three resident bedrooms which are furnished with a bed, linens, night stand, chest of drawers and a closet.

Bathroom - There are two bathrooms located in the facility. LPA Spaeth tested the water temperature in bathroom one at 9:50 am which was 105.0 degrees F. Both bathrooms contained hand soap, paper towels, trash can, and grab bars. However, the bathrooms did not contain slip resistant mats.

Staff Room - LPA observed the staff room which was not locked and contained staff medication.

Smoke/Carbon Monoxide Detectors – The detectors were tested at 10:15 am and observed were operable.