Facility Evaluation Report

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual visit. Upon arrival LPA met with staff and explained the reason for the visit. Administrator was contacted and arrived shortly.

LPA and staff toured the physical plant areas approximately 2pm: The facility has seven (7) bedrooms and eight (8) bathrooms currently occupying six (6) resident private bedrooms. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, Hospice waiver for six (6). There is a dedicated area for the posting of required documents directly by the main entrance and hallway.

All resident bedrooms observed properly furnished with a bed, night stand, chair and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Extra linens are kept in cabinets in the hallway nearest bedroom. LPA observed a sufficient supply of linen, personal hygiene supplies, PPE, First aid kit and supplies stored at this location as well. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured in all bathrooms ranged between 109-116 degrees Fahrenheit. Living and dining room furniture were also checked. Dining room furniture were observed to be in good condition and appeared to be relatively clean. The facility maintains a comfortable temperature. The carbon monoxide/smoke detectors were tested and observed not functioning properly. Administrator contacted electrician during the visit and scheduled repair service. The fire extinguishers were fully charged and last serviced on 03/29/2025. Kitchen area was sufficiently stocked with perishable and non-perishable food properly stored. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas observed clean. Knives and sharps are observed to be kept in a locked drawer to the left of the sink. (Continue to LIC 809c).