Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Administrator (Admin) Heidi Baha and explained the reason for the visit. Administrator (Admin) Guibilondo holds a valid certificate expiring on March 1, 2027.

The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to three residents at one time. During today's visit, two residents were under hospice care, two caregivers were on duty providing care to five residents who were observed relaxing in the living room and their respective bedrooms.

LPA toured the physical plant with Admin. Facility is clean, operational, and in good repair with the exception of one resident bedroom. The hardwood floor and closet door are being repaired due to the water damage. The Department was not notified of the alterations being made prior to the renovations. LPA observed five resident bedrooms and bathrooms. There is one additional staff bedroom shared by two staff. Resident bedrooms had all required furnishings. Bathrooms were in compliance, clean, and operational. The hot water temperature measured at 107.2, 105.8, 105.9, 105.2, and 105.8 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient water in the pantry walk in closet. There were no emergency food observed. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility.