Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by staff on duty. During the visit, LPA met with facility administrator (AD) Juan Garcia Trujillo about visit. For this visit, there are 2 staff members on duty, of who are background cleared and associated.

The PUB475 "See Something, Say Something" poster was observed to be located in the hallway LPA observed the Administrator's Certificate for Juan Garcia Trujillo which expired on 2/7/2023, however, AD provided proof to LPA of ongoing renewal classes and fees, to which LPA observed were active.

LPA toured the interior and exterior portions of the facility with AD Trujillo The facility is a two-level structure and is licensed for 6 non-ambulatory residents, of which 0 may be bedridden and 2 may be on hospice. For this visit, there are a total of 3 residents in care, of which 1 is on hospice.

On the first floor, there are a total of 3 resident bedrooms, of which all are shared rooms, and 1 bathroom. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. On the second floor, there are a total of 2 bedrooms and 1 bathroom, of which is only designated for staff use. LPA observed that there are no residents or resident belongings residing on the second floor. Water temperature in restrooms were measured to be at 110.1 degrees Fahrenheit.