Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with Laura Aguilar who assisted with the visit. LPA explained the purpose of the visit. During the visit, the CARE tool was used. The facility is licensed to serve six (6) non-ambulatory residents and has an approved Hospice waiver granted for 6 residents.

The facility is a single-story home, located in a residential area, that consists of a living room, dining room, five (5) resident bedrooms, three (3) bathrooms, a kitchen, detached garage and laundry room. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained. Facility has a 5ft fenced pool. There is a shaded seating area for the residents located in the backyard. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Additional food supplies observed in the garage. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly. Sharps are locked and inaccessible to residents. Cleaning solutions and disinfectants was observed locked in the laundry room and in the garage. Two (2) Fire extinguishers were observed at the facility and are fully charged. Carbon monoxide / Smoke detectors were observed throughout the facility and were tested and operable. The common areas (dining room, living room) are clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. There is closet space for clothing and other belongings. Extra clean linen was observed in the hallway closet.