Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced visit at the facility for the purpose of conducting the required annual inspection using the CARE Tool. LPA met with Supervisor Julia Elias and and the purpose of the visit was discussed

The facility is a large 2 story building with (93) client rooms licensed to serve up to (185) clients of which ten (10) may be ambulatory. The overall structure is described as 2 connected buildings known as Building A and Building B. Building A houses the main lobby, medication room, kitchen, dining room and two laundry rooms. Building B consists of a quiet room, TV room, an activity room, 2 laundry rooms and 3 offices. The (93) rooms are among the first and second floor of each building. Each client room has their own bathroom. Based on the client population being served and the census, at the time of this visit, the facility is operating within the conditions and limitations specified on the license. LPA toured the physical plant and observed the following rooms: #7, #8, #10, #11, #12, #26, #30, #41, #103, #108, #204, #205, #211, and #214 Accommodations : Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Client Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is a phone for Client use. Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates observed. Smoke Detectors & Fire Extinguishers: Fire and CO2 detectors are connected to Fire Panel and last serviced 4/23/23. Fire Extinguishers observed throughout Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -115 degrees all around the facility. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to clients. First aid kit observed. Postings: Postings observed. Residents & Staff Files : LPA reviewed fourteen (14) Client medications records and files , as well as ten (10) Staff Files . Emergency Disaster Plan, Plan of Operation and Infection Control observed.

Inspection tool completed and, per Title 22, deficiency is being cited. See 809-D page. Exit Interview conducted and a copy of this report and appeal rights discussed and provided.