Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado conducted an annual required visit. LPA met with caregiver Jonathan Diel and explained the purpose for the visit. Caregiver Tita Bartolata called Administrator Teresita Maralit to notify her of the visit. LPA used the Infection Control Tool to evaluate the facility. LPA inspected the physical plant with caregiver Tita, reviewed COVID-19 procedures, residents' medications, resident and staff files, and observed the food supply. Facility has submitted a mitigation plan and the plan was approved.

The facility consists of (5) bedrooms, of which (1) is for live-in staff, (3) bathrooms of which (1) is for live-in staff, a living room, kitchen, dining room, TV room, shaded patio in the backyard and a detached garage. All resident bedrooms were toured and observed to have a smoke detector, the required furniture, linens, and sufficient closet and storage space. All bathrooms were observed to have a toilet, shower, and wash basin. The staff bathroom has a Jack & Jill hand wash sink and the sink to the right side was observed to be broken and inoperable with a bag covering it. Staff stated her boss is aware of it. The resident bathrooms were observed to have the required non-skid mats and grab bars. The hot water was tested and measured at 116*F in the staff bathroom and 131.5*F in the resident bathroom. The second resident bathroom did not have any running hot water at the hand wash sink. The staff stated her boss turned off the hot water to keep residents from burning themselves. The hot water requirement is currently not being met. The kitchen was toured and all appliances were operating properly. There was a sufficient amount of perishable and non-perishable food in the kitchen refrigerator, the kitchen pantry, and the refrigerator in the garage. LPA observed the vent in the dining area to be full of dust. The cabinets underneath the kitchen sink are broken and appears to be leaking. A tub of water was observed under the sink with some pads laid on the floor to absorb the water. All sharps were observed to be stored in a drawer next to the kitchen sink, however the lock on the drawer is broken, making the sharps easily accessible. LPA observed a cabinet near the entrance of the laundry room to the right, that stored cleaning supplies/toxins and laundry supplies