Facility Evaluation Report

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met with Raquel Tuazon, Administrator and the purpose of today’s visit was explained.

There are currently (2) residents in the facility . (1) residents are ambulatory, (0) are non-ambulatory, (1) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (5) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and attached 2 car garage.

LPA and Raquel toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. Bedroom 5 is a staff bedroom. The (3) bathrooms have grab bars and non-skid mats and are clean and operational. Smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (1) fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.