Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with Maria Reylene Urgelles for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant w as conducted at around 2:00 PM and the following was noted:

There is one entrance being utilized at the facility. The facility has a total of five (05) bedrooms, of which one (01) is a staff room and a total of two (02) bathrooms for both residents and staff.

The facility is fire cleared for six (06) ambulatory, of which three (03) may be non-ambulatory, one (01) may be bedridden and a hospice waiver for six (06). The facility is currently occupying five (05) 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 laundry and storage. 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. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 74°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located kitchen and observed to be fully charged.