Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility administrator Shahin Mokhtazad after stating the purpose of the visit.

There are currently six residents in care, two of which are receiving hospice care at this time. LPA observed residents relaxing in the facility's common living areas or in their respective bedrooms. Two residents are away in the community also. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has six private bedrooms along with two staff rooms.

Bedrooms appear clean and sanitary. Some of the residents are using half rails or full rails for postural supports. Physician orders requested during the visit and faxed by the hospice provider. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 117F in two separate bathrooms..

LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items and the medication central storage are verified to be secured. Cleaning supplies and supplements are observed to be stored without being secured. Type B citation issued.

The two wall-mounted fire extinguishers are charged, with up-to-date maintenance tags attached. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The garage is inaccessible to residents and used for laundry as well as additional storage of food and supplies.