Facility Evaluation Report

Licensing Program Analyst (LPA), Leizl de la Cerra, conducted an unannounced annual inspection at the facility mentioned above. At 10:45am LPA was greeted by the Administrator and LPA explained the reason for the visit. Administrator granted LPA access to the facility.. The facility currently has no residents,

Facility is licensed to serve six (6) non-ambulatory residents, one (1) may be bedridden in room #3. The facility also has an approved hospice waiver for two (2) residents. The Annual Licensing Fees are current.

With the assistance of the administrator, LPA conducted a physical plant inspection at 11:00am and following was observed.

Bedrooms: The facility has a total of three (3) bedrooms. Three (3) bedrooms are designated for the residents. LPA observed all bedrooms are properly furnished and clean, All rooms have sufficient lighting.

Bathrooms: LPA observed two (2) bathrooms. Appeared to be clean and in good repair. Well stocked with toilet papers, soap and paper towels. LPA observed the appropriate grab bar and non-skid mat. The hot water temperature measured at 112.6°F.

Common Areas : The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards observed. There is a fire extinguisher by the dining area observed to be operational.