Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Mylyn Castillio, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasada was notified of the visit by phone call. There are two (2) residents residing within the home.

The following 4 (CARE) tool domains were observed and reviewed: Physical Plant/Environment Safety, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

· LPA conducted a tour of the facility including three (3) resident bedroom, the living room, dining room, kitchen, and backyard area. Facility was observed to be clean and in good repair.

LPA reviewed the records for two (2) residents for appraisals, physician's reports, admissions agreements.

· The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary.

· Medications along with the Medication Administrator Records (MARs) were reviewed for two (2) residents.

Due to time constraints, the annual inspection will be completed at another date. Exit interview held and a copy of the report was provided. .