Facility Evaluation Report

License Program Analyst (LPA) Shannan Hansen arrived at 1:30 PM to complete an unannounced annual inspection and met with Maria Lepe, House Manager. There is a total of 5 residents.

LPA reviewed Client and Staff records and centrally stored medication record, to complete this annual inspection.

A review of five clients and a sample review of two staff records as well as two client’s medications was conducted. LPA reviewed client’s files at 1:35 PM on 7/25/2023 and learned that 5 of 5 clients have an updated reappraisal/needs & care plan and physician’s report. P&I's are kept in a locked filed cabinet in the facility office room; facility responsible for all client’s P&I and money; facility had P& I and ledgers available during the visit. P& I money not comingle, and ledgers are current on 7/25/2023 at 1:50 PM.

Medications were centrally stored in a locked filed cabinet of facility office on 7/25/2023. LPA conducted a review of medications for two clients. The Medications of 2 of 2 clients were found to be given according to physicians’ directions on 7/25/2023 at 2:15 PM. Centrally Stored Medication Records (CSMR) on 7/25/2023 at 2:15 PM were currently for 2 out of 2 clients in the facility.

LPA conducted a sample review of staff records at 2:30 PM on 7/25/2023 and learned that all staff present at the facility and other individuals who require caregiver background checks have received criminal record clearances or exemptions. Facility has proof of Direct care staff training. LPA was presented with proof of CPR & 1 st Aid certification for staff records that were reviewed. Maria Lepe Administrator Certificate # 6061120735 expires on 11/29/2023.