Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit.

The facility is a single level structure and licensed for six non-ambulatory residents. The facility currently has six residents and five residents were present during the visit, one resident has been hospitalized for weeks. There’s a total of five bedrooms (4 resident & 1 staff), and two restrooms available. There’s a living room space, a dining space, laundry area, backyard area and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured at 105 degrees F. Kitchen: Stove was observed to be operational. Sharps are stored below the sink in a cabinet with a lock on it. Food Service: A food supply that meets regulation requirements was observed.

Client & Staff Files : Resident and staff files are stored in the dining room and are not secured. Licensee/Administrator Corazon was advised all files need to be securely stored.

File Review: Four resident files and one staff file were reviewed during the inspection.

Medications/First-Aid Kit: Resident medications are stored in a locked medication cart across from the dining table. A first aid kit with all the required elements was observed in the living room.

Medication Review: Medications for five residents were observed. There was no medication list or medication administration record for LPA to reference when checking medication.