Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting a case management visit to cite deficiencies found during a health and safety check. LPA Maldonado met with Rhonwinn Hipolito- Executive Director (ED) & Michael Forsgren- Operations Manager (OM) and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the resident and staff roster, Facesheet and Physician's Reports for Residents# 1-5 (R1-R5), and conducted a tour of the physical plant, including rooms and restrooms (RR) for R1-R5, with assistance of ED and OM. LPA discovered the following:

R1's room had a foul smell. Private RR was inspected and toilet was observed to be splattered with feces around the seat. R1 stated RR has not been cleaned in a while (unable to specify time) and has asked staff several times for cleaning services, but has not received it. Per Needs and Services Plan, R1 is to receive housekeeping and Laundry services once a week and as needed. R2's room carpet was observed to be dirty and had dark spots throughout, as though something was spilled. R2 stated it has been this way for some time (unable to specify time). R4-R5 share a room. R4's blanket on the bed was observed to have 3 small feces stain. R4 stated it needs to be washed, however staff do not pick up the laundry and R4 has to take their belongings to the laundry room, located at the end of the hallway. Per R4's Needs and Services Plan, R4 is non-ambulatory, making it difficult for R4 to bring their laundry basket to the laundry room. Per R4-R5's Needs and Services Plan, housekeeping and Laundry services are to be provided once a week and as needed. RR was inspected and noted to smell like urine, non-skid mat was not observed in the shower, and the shower was dirty. A soiled brief was observed in a trash can near R4's bed that did not have a lid. R5 also stated if assistance was required, it would be hard to call for help using the call system in their room due to it being inaccessible by furniture placed in front of it.

During today's visit, deficiencies were observed and will be cited on LIC809-D.

An exit interview was conducted and a copy of the report and appeal rights were provided.