Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Lourdes Sandoval caregiver and explained the reason for the visit.

Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (6) may be bedridden, and has a hospice waiver for (6). The facility is a single home in a residential area and consist of a kitchen, a living/dining room, with 6 resident rooms, 2 bathrooms, a laundry area, a detached garage, a front yard, and a back yard.

LPA reviewed the following CARE inspection tool domains during this visit:

Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Plan was last reviewed on 6/10/24.

Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license.

Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Lourdes Sandoval and observed the following: Facility was observed in good repair indoors and outdoors. Living room/dining room is clean, and providing sufficient seating area, and lighting. Kitchen area is clean and inaccessible to residents, sharps, medication, and cleaning supplies were observed locked in cabinets in the kitchen area. Six (6) resident rooms were observed clean with sufficient lighting, furniture, and bedding supplies. Full bed rails were observed in bedroom #2 and #3. (CONTINUED ON LIC 809C)