Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan, met with staff Teresa Giron for a One (1) Year Required visit for this facility. Ms. Giron called the Administrator Claudia Gutierrez and explained the reason for the visit. Administrator designated Ms. Giron to sign the report.

A tour of the physical plant was conducted with the administrator at 12:19 PM. The facility is a single storey house with a total of three (3) bedrooms and three (3) bathrooms currently occupying four (4) residents. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden in Room #1. Hospice waiver for six (6) residents.

Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted:

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

BEDROOMS are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. BATHROOMS were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.1°F to 117.2°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. (continued on LIC 809-C)