Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregivers and explained the reason for the visit. Lead Caregiver (LC) Frederic Espiritu arrived shortly to help with the visit. Facility is licensed for six non-ambulatory residents, with a hospice waiver for two. Currently there are four residents, of which two are on hospice during today's visit.

LPA Tea along with caregivers toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, three full bathrooms, living room, dining and kitchen area, and a caregiver area. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. The bathroom flooring in Room #3 was unstable, and LPA observed loose floor tiles. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 109.9 to 113.7 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen cabinet. LPA also observed toxin substances locked and inaccessible to residents underneath the kitchen sink. Fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit.