Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 1:45pm. During today’s visit, LPA met with Miriam Esquivel, Administrative Designee . At time of entry two residents were at Day Program and two were present in the facility.

The facility is a three bedroom, two bathroom single story residence with an approved fire clearance of four ambulatory ; two non-ambulatory residents of which two are approved for hospice. The facility currently has a census of four residents in care.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 111.2 and 117.0 degrees Fahrenheit and all smoke detectors were operational . The fire extinguisher is charged and was serviced on March 7, 2025. The facility’s fire drill is scheduled for April 10, 2025 and was last done in December 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . Emergency supplies are stored in the living room LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit has all the required elements and facility has a First Aid book.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. One of four resident files did not have an Admissions Agreement for this facility and had transferred