Facility Evaluation Report

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met with Ivan Bravo, Administrator and the purpose of today’s visit was explained.

There are currently (2) residents in the facility. (2) residents are ambulatory, (0) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (4) bedrooms, (3) full bathrooms, living, room, dining, kitchen, shaded back yard, front yard, and laundry room inside the detached 1 car garage.

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-3 are occupied by residents and contain the mandated furniture. Bedroom 4 is a staff bedroom. The (2) bathrooms have grab bars and non-skid mats and are clean and operational. 3rd bathroom is a staff bathroom. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file was current and medications were not current (doses missed- 1 pkg (gabapentin 100mg zolpiem 5mg - 2days missed) 1 pkg- (Buspirone 5mg Dicyclomine 10mg - 1 day missed): 1 pkg - (Gabapentin 100mg dicyclomine 10mg Buspirone 5mg - 1 day missed). (1) Staff file was not current (CPR card expired 2018). Ample supply of perishable and nonperishable food, hot water temperature is (120) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (2) fire extinguisher is fully charged. The facility is in good repair.