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 Dianna Manalo, Administrator arrived to the facility and met with LPA.

The facility is licensed for five (5) non-ambulatory residents, one (1) bedridden with approved hospice waiver for four (4) residents. Currently, there are five (5) residents at the facility and there are no residents receiving hospice services currently. This is a single story with attached garage facility. The facility has four private resident rooms, one shared resident room, one staff room and two full bathrooms.

LPA accompanied by staff 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 in a freezer located in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in the hallway. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed the first aid kit with necessary items. LPA inspected the facility bathrooms (2) and LPA measured the hot water temperature which measured 109.2 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as

This report was reviewed with the Administrator, and a copy of this report was provided to the facility.