Facility Evaluation Report

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Irene Formentera, Administrator and the purpose of the visit was discussed.

The facility is licensed to serve 6 non- ambulatory residents. All 5 rooms are cleared for bedridden fire clearance. Facility approved to admit or retain 2 residents on hospice. The facility is 8775 compliant. Currently 2 resident has dementia, 1 resident receiving home health and 2 resident on hospice care services. The facility does not handle any of the residents’ money.

This home is a single story home consisting of: (6) resident bedrooms, (1) staff room (3) Full bathroom, , living room, kitchen with dining area, laundry room (located in the attached garage) and an outdoor shaded patio area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 110F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

During todays visit LPA did not observe any deficiencies. Exit interview with Administrator Irene Formentera.