Facility Evaluation Report

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Administrator (AD) Angelita David. AD's certificate expires on 7/16/2025.

The facility is a single story building with an approved fire clearance of six non-ambulatory residents and a hospice waiver for three. The facility currently has no residents in care. LPA along with AD toured the facility at 9:15 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 3 resident bedrooms, living room, dining room, 3 staff rooms, and kitchen as well as 5 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA toured the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Outside grounds were toured. Walkways around the home were clear of hazards. First aid kit contained all required items including tweezers, scissors and thermometer. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food supply. LPA reviewed 2 staff files and 4 former resident files. LPA interviewed AD regarding the reason for no residents. AD planned to close the business but will now have a family member assume day to day activities.