Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Barbara Boiston, House Manager and explained the reason for the visit. The facility is approved to serve residents age range 60 and above, approved for six (6) non ambulatory residents in bedrooms 1 through 3. Bedroom #4 is for staff use only. Hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs prior to being around residents. Bathroom has hygiene items such as paper towel, hand soap and toilet paper.

Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. LPA observed uncovered left over food in the refrigerator and food containers were not labeled. LPA also observed that the kitchen cabinet lock where cleaning supplies and chemicals are stored is broken.

Due to time constraints, LPA will return at a later date for a continuation visit. LPA will complete the remaining domains: Operational Requirements, Physical Plant & Environment Safety, Staffing, Personal Records-Training, Resident Rights-Information, Planned Activities, Incidental M & D, Resident Records-Incident Reports, Disaster Preparedness, Residents with SHN.

Exit Interview conducted and a copy of the report was provided to the House Manager, Barbara Boiston