Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the caregiver. The Administrator Stephanie Domingo arrived at 10:00 am. LPA stated the purpose of the visit was to conduct an annual inspection. The Administrator confirmed there are five residents living in the facility. The facility is licensed for six (6) non-ambulatory residents. Two (2) of the six (6) can be bedridden residents.

LPA Spaeth and the Administrator toured the facility at 10:15 am until 11:00 am..

Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room contained a dining room table and chairs.

Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a kitchen cabinet.

Kitchen – LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. The fire extinguisher was located near the kitchen and was operable. The Administrator opened a kitchen cabinet but observed the lock using a magnet did not properly work. LPA stated to the Administrator that a secure lock will need to be installed. Cleaning solutions were locked underneath the kitchen sink.

Laundry Room – The laundry room door has a key-punch lock system. The door was slightly opened and was not securely locked. LPA observed the washer/dryer and the laundry detergent.