Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Assistant Administrator Belen Taico. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. The facility is located in a residential neighborhood that consists of 4 resident rooms, 2 bathrooms, dining room/ living room, office, laundry room, medication/storage room, outdoor patio area, and detached garage. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed.

Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs).

Operational Requirements: A hospice waiver for 4 residents is in place. A fire clearance for (6) non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 8/26/2024.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The facility has (3) fully charged fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Facility has a fire pull-alarm in the dining area.

Staffing: A total of 5 staff members provide care and supervision to the clients.

Personnel Records/Staff Training: Administrator certificate expires 11/14/2025. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health and TB clearance, and 1st Aid/CPR training are on file.