Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Assistant Administrator (AAD) Araceli Lee and explained the purpose of the inspection.

During the inspection LPA and AAD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a two-story home with two resident bedrooms, one staff bedroom, two bathrooms, and attached two-car garage on the first floor. The second story is used solely as staff quarters. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The back yard has a shaded sitting area. Residents were not present during the visit as they were away at day program. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 122.6 degrees Fahrenheit; a Technical Violation was issued on today's date. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged and service tag indicated it was last serviced on February 4, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Sharps, all and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA reviewed medication and Medication Administration Records (MARs) for two of two resident and did not observe any discrepancies. LPA conducted record review of two of two resident files and two staff files. LPA interviewed staff present. (Cont. LIC809-C)