Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPA was greeted and granted entry into the facility by Caregiver 1 (CG1). LPA Quiroz called Administrator (AD) Vivian Ann Ortiz-Luis and explained the nature of the visit. (AD) Ortiz-Luis arrived during today's visit.

This facility is licensed to provide services to age range 60 and over, approved for six (6) Non-Ambulatory Residents of which 1 (one) may be bedridden in Room #3 only, and has a hospice waiver for six (6) residents. There are four (4) residents in care of which (3) three residents are receiving hospice care services There are no active COVID-19 cases in the facility at this time. Administrator Ortiz-Luis has an Administrator Certificate with expiration date of 9/8/2025.

LPA Rosie Quiroz along with (CG1) toured the interior and exterior of the facility. During today's inspection tour, LPA Quiroz observed two of four residents in their bedroom resting and 2 of four residents in the dining area with staff supervision. LPA Quiroz interacted and interviewed with staff and residents during today's visit.

Between 10:06am-10:20am while conducting inspection tour of the kitchen area, LPA Quiroz observed expired condiments, food items and expired canned food with expiration dates varying from 6/1/2020- 10/19/2023. This was verified with (CG1) and (AD) Ortiz-Luis. (See LIC 809-D)

LPA Quiroz inspected resident's bedrooms and bathrooms. Water temperatures were recorded to be between 107.7-109.4 degrees Fahrenheit. LPA Quiroz inspected resident’s bedrooms and appeared to be clean. Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits. LPA Quiroz observed the emergency and disaster and evacuation plan. Facility has a supply of emergency food, water and PPE in garage area readily available for staff and residents. LPA Quiroz toured the outside of the facility and observed seating and shaded area backyard for residents and visitor's enjoyment in backyard area. CONTINUED ON NEXT LIC 809-C PAGE...