Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with Alan Hurtado for a One (1) Year Required annual inspection visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:50 PM and the following was noted:

There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and three (03) bathrooms. The facility is fire cleared for two (02) non-ambulatory in room# 1, two (02) bedridden/transfer dependent in room #2, two (02) ambulatory in room #3 and a hospice waiver for one (01). The facility is currently occupying four (04) residents.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away.

Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. Living and dining room furniture were also checked.