Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the staff member. The Administrator Stephanie Domingo was called. LPA stated the purpose of the visit was to conduct an annual inspection. The staff member confirmed there are two 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 staff member 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 is furnished with comfortable seating and a television. The dining room is furnished with 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 is located near the kitchen and was operable. The medications are locked in a cabinet and the knives are locked in a kitchen drawer. Cleaning solutions are locked underneath the kitchen sink.