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 Eleazar Cuyson was notified via telephone and arrived later to assist with the visit.

There are currently six 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. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with an attached garage, with two private bedrooms, two shared bedrooms. There are are one shared and one en-suite bathrooms on the premises. The upstairs portion of the house is strictly for staff use and verified not to house any residents during the visit.

Bedrooms appear clean and sanitary. Two resident receiving hospice care are observed to have a bed equipped with full-length bed rails. 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 126.2F and 132.2F at two separate faucets used for personal grooming. Type A deficiency cited and civil penalty assessed for repeat violation..

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.

The fire extinguishers present are charged with up-to-date maintenance tag. Carbon monoxide and smoke detectors were found to be present and operational. CONTINUED ON FORM LIC809-C