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 caregiving staff after introducing himself and stating the purpose of the visit. Administrator Russell Venanzi was notified of the visit via telephone. Assistant administrator Tommy Tran arrived later to assist.

There are currently five residents in care, three of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. Two resident interviews conducted during the visit. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with an attached garage, with four private bedrooms and one shared room. The upper level is strictly for use by caregiving staff. There are two shared bathrooms used by residents, one in the hallway and one en-suite from the shared bedroom.

Bedrooms appear clean and sanitary. Full rails postural supports are in use on multiple beds at the time of the visit. Hospice plans of care reviewed for two such residents, orders confirmed to be on file. A third resident does not receive hospice care and is stated to not use the rails, which are observed in the lowered position. Staff removed the rails after stating the resident did not use the rails for support. 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 109F in one of the shared bathrooms.

LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. CONTINUED ON FORM LIC809-C