Facility Evaluation Report

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and William Vanegas for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Staff #1 (S1) Narciso De Guzman and discussed the purpose of the inspection. Administrator (AD) Anna Mallari appeared via telephone.

LPAs reviewed Infection Control requirements. At about 10:15AM, LPAs and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 5-bedroom, 2-bathroom, one-story house with detached garage that is used for storage. There is a back yard with seating for the residents. LPAs observed 3 staff and 4 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPAs inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 106 degrees F and 111 degrees in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and laundry room. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 11:15AM, LPAs reviewed 4 resident files and 3 staff files, interviewed 2 residents and 2 staff, inspected medications for 4 residents, and inspected resident money and ledgers for 4 residents.