Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Corazon Lopez and explained the reason for the visit. The facility is licensed for a capacity of six, approved for six non-ambulatory, with a hospice waiver for two. Currently there are five residents, and there are two on hospice during today's visit.

LPA Tea reviewed five resident files. Resident files contained most of the required documents but was not organized and difficult to decipher for the required documents. The staff records were not available. AD Lopez is working on organizing and compiling the staff records together. LPA did observe that staff training is current. The administrator certificate expires on February 28, 2027.

LPA Tea along with administrator toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home is a one-story facility that consists of four resident bedrooms, one staff private room, 2 full bathrooms, living room, kitchen, dining area, and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 105.8 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements