Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Charlita Ariola and the purpose of the inspection was discussed. Administrator (AD) Angelo Buenaventura was notified of the inspection and arrived at approximately 9:30 a.m.

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

This is a one-story home with four resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 107.2 - 114.9 degrees Fahrenheit.

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. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Medication was observed to be centrally stored and locked in a hallway storage closet. LPA reviewed four resident files and three staff files. One of four resident files did not have an appraisal dated or signed in the last twelve months; a Deficiency was cited on today’s date. Two of three staff files did not include staff training conducted on hospice, restricted health conditions, or postural supports; a Deficiency was cited on today’s date. LPA interviewed three residents and two staff. (Cont. LIC809-C)