Facility Evaluation Report

Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with Administrator Nick Mai and stated the purpose of this visit.

The facility is a single level structure and licensed for six non-ambulatory of which two may be bedridden with a hospice waiver for six. This facility is a Residential Care Facility for the Elderly/Dementia.

At about 11: 26 am, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed 3 residents in care and Administrator on duty. LPA toured the interior and exterior portions of the facility. There were 3 resident rooms 2 of which had the potential of being shared rooms. One room is vacant and used for storage. Facility had a staff room which is kept inaccessible to residents. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 114.8 degrees Fahrenheit. LPA noticed cleaning supplies in one of the restrooms. Administrator immediately removed cleaning supplies from residents in care. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed.