Facility Evaluation Report

At 1:30 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

It is a two story building with 6 bedrooms, 4 bathrooms, kitchen, garage, common areas, and outdoor areas. The second-floor stairway is locked and inaccessible to residents. It has an approved fire clearance for 6 non-ambulatory residents, of which 1 may be bedridden in Bedroom #1. Approved hospice waivers for six (6). The facility uses surveillance cameras on the exterior and in common areas.

Kitchen: At approximately, 1:40 PM, LPA toured the kitchen area and observed an adequate supply of perishable and non-perishable food in the kitchen. Surfaces were sanitary and appliances were functional. The stove hood was free of debris. Sharps were locked by the refrigerator, and cleaning solutions locked in the laundry area which was next to the kitchen. The washer and dryer were in good repair and functional.

Bedrooms: LPA observed total of six (6) private bedrooms designated for resident use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has an awake staff.

Medications: At 1:45 PM, LPA observed medications are centrally stored and locked in the hallway by bedroom # five (5) in a cabinet.

Bathrooms: LPA observed four (4) bathrooms and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and residents' bathroom had non-skid mat. Hot water temperature measured at 116.8°F. Continue on LIC809-C