Facility Evaluation Report

Licensing Program Analysts (LPAs) Cynthia Chan and Elena Mallett conducted the required annual inspection. LPAs met with the House Manager, Barbara Boiston, and the purpose of the visit was explained. The fire clearance has been approved for a capacity of 6 residents, of which (4) may be non-ambulatory. The hospice waiver is approved for 1 resident.

LPAs inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

Facility is continuing to follow their Infection Control plan. The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility. The facility is a single story home with 6 bedrooms (5 for residents and 1 staff bedroom), 3 bathrooms, living room, dining room, family room, kitchen. The facility has a swimming pool in the backyard and is surrounded by a locked gate. Bathrooms have non-skid mats in the shower area and grab bars. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The backyard has tables and chairs for residents to use. The facility has auditory devices at the exit doors. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. The kitchen is kept clean and sanitary. The facility has sufficient space to accommodate indoor and outdoor activities. LPA reviewed 3 staff files and the CPR & First aid certificates are current. LPA reviewed 6 resident files and the following documents are found - admission agreements, Identification & Emergency Information, Physician's Report, Consent forms, Resident rights, Safeguards for Personal Property Valuables form. There are 3 residents receiving hospice services and one resident on oxygen. Medications are centrally stored and locked. Resident medications are being given as prescribed. The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Emergency Disaster Plan is updated and reviewed annually.

A deficiency is issued on the LIC809D form. An exit interview was held and a copy of this report was given to Barbara Boiston.