Facility Evaluation Report

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an

unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were

greeted and granted entry by facility caregivers after introducing themselves and stating the purpose of the

visit. Administrator Bryan Estorba was notified by telephone and arrived later to assist with the visit.

LPAs accompanied by facility staff conducted a tour of the physical plant and observed the following: the

facility is a one-story home with an attached garage. The facility has four private bedrooms and one shared bedroom. All resident bedrooms have the required furnishings. LPAs observed all beds have linen and blankets. There are full rails used for postural support in two rooms. Physician orders for both were reviewed, along with the hospice plans of care. There is one shared bathrooms, which is observed to be equipped with grab bars and slip mats. Bathrooms faucets and toilets are operational. Water temperature was measured at 114.4F.

There are currently four residents admitted to the facility, including one admission who is currently in a skilled nursing facility for rehabilitation. There are two residents receiving hospice care. LPAs observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly and documented. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Some canned good in the garage are however observed to be expired. Type B citation issued. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present is fully charged and has been maintained in 2024.