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 Joana Crisostomo. Assistant Administrator (AAD) Denise Molde arrived at approximately 12:00 p.m. and the purpose of the inspection was discussed.

During the inspection, LPA and Staff Crisostomo 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 five 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 116.2-116.6 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. LPA reviewed five of five resident files and one staff file. Two of three staff files requested for review are not being maintained at the facility and were not available for review; a Deficiency was cited on today’s date. One of one staff file reviewed did not contain any documentation for initial staff training or staff training conducted in the past year and AAD was unable to provide LPA with a copy of staff training conducted; a Deficiency was cited on today’s date. LPA interviewed two residents and two staff. (Cont. LIC809-C)