Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required Annual visit. This annual had a specific emphasis on infection control practices and procedures. LPA Ascencio met with staff member at 10:40 a.m. and explained the reason for the visit. Administrator Izhak Illouz arrived at the facility shortly thereafter. LPA Ascencio toured the physical plant areas inside and outside, with Administrator Izhak Illouz at 10:45 a.m. to ensure there are no health and safety hazards.

BEDROOMS: There are (6) six bedrooms designated for resident use and (1) one bedroom designated for staff use. All resident bedrooms are private rooms. Bedroom #3 and Bedroom #4 have a direct exit to the exterior. All resident rooms are set up with beds, night stands, lamps, chests of drawers,

chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean

linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a

bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for

RESTROOMS : Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. LPA observed sufficient amounts of soap and paper products. There are 4 total bathrooms at the home. Two (2) are private bathrooms in Room # 2 and 3. Room #1, 4, 5 and 6 use two (2) shared bathroom. Hot water temperature was tested throughout the home and was within normal ranges between 105.0 F and 120.0 F.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and

good condition. At the time of the visit, common seating area and dining room furniture was

observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social