Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan, met with Administrator Rima Abelian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 12:22 PM and the following was noted:

There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard.

The facility has a total of four (4) bedrooms and three (3) bathrooms. One (1) of the bathroom is designated for staff use only. The facility is fire cleared for six (6) non ambulatory residents, one (1) of which maybe bedridden on Room #3. Hospice Waiver for two (2) residents.

KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the cabinet in the bedroom hallway which was locked during visit.

BEDROOMS: There are three (3) shared bedrooms for clients' use and two (2) bedroom for designated for staff use. The residents' bedrooms are furnished with beds, night stand, chairs, dressers, bedding and linen and have sufficient lighting and storage. (continued on LIC 809-C)