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 Rozina Amlani was notified of the visit via telephone and arrived later to assist.

There are currently six residents in care, three 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. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has four private and one shared bedrooms along with one locked staff room. There are two bathrooms on the premises.

Bedrooms appear clean and sanitary. Two residents are observed using full-length rails as postural supports along with two residents with half rails. Physician orders and hospice plans of care reviewed. 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 and 111F in two separate bathrooms equipped with faucets used for personal grooming.

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 secured.

Fire extinguishers present are charged with up-to-date maintenance. Smoke and carbon monoxide detectors were found to be operational. CONTINUED ON FORM LIC809-C