Facility Evaluation Report

Licensing Program Analysts (LPAs) Galarza Nune Margaryan conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Ana Duenas. There are currently 4 elderly residents 60 years and older residing in the facility. One (1) resident is receiving hospice care, one (1) resident receives home health, one (1) resident has Dementia, and one (1) resident is bedridden. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed.

Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility submitted a COVID-19 Mitigation Plan, but an Infection Control Plan has not been submitted.

A current Plan of Operation was reviewed.

The facility has a Dementia Waiver in place. A Hospice Waiver for 3 is approved.

A fire clearance for 5 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only.

Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is expired. Licensee/Administrator has not renewed the policy in several years.

A surety bond is not applicable. Facility does not handle resident's money.