Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. LPA met with Rico Mico, Administrator and explained the nature if the visit. There are five residents at the facility and there are two residents receiving hospice services currently.

LPA accompanied by Administrator began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage located in the garage in a freezer and a spare refrigerator. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in the bedroom hallway. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. Medication cross checked for accuracy of date and dosage. LPA inspected the bathrooms, and LPA measured the hot water temperature which measured 107.9 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked in the garage. The facility has an available clean supply of linens in the hallway storage and a