Facility Evaluation Report

Licensing Program Analysts (LPA's) Jenifer Tirre and Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA's were greeted and granted entry into the facility and explained the reason for the visit. LPA's toured facility with Supervisor Juanita Gonzalez

Facility is a single story, 3 bedroom with 2 bathroom home. There are 3 Residents in care. LPA's observed proper covid signage in entry way of facility. Facility has required Department postings. LPA's observed copy of Administrators Certificate expiring 11/21/2023. LPA's toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper and paper towels. Proper hand washing signs posted in restrooms. Water temperature measured at 113.9 degrees . LPA's observed visitation areas with ample seating. Residents were observed relaxing in the Living room watching TV. Facility has working audible alarm system, Carbon Monoxide detectors and smoke detectors. Facility has 2 fire extinguishers fully charged. Facility has emergency food and water supply. Facility has required Emergency Disaster Plan. Facility has a secured location for resident medication and files. LPA's observed residents medications and facility has 30 days supply of medications for Residents. Residents emergency contact information and Physicians reports are current. Facility has supply of PPE supplies.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator Shimon Cagan and a copy of this report was left at facility.