Facility Evaluation Report

On 7/24/2023, at 11:45 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Administrator Kanisha Arzu who was informed of the purpose of visit. The facility is made up of four (4) resident bedrooms and two (2) bathrooms. The facility is approved for six (6) non-ambulatory residents of which one (1) may be bedridden. The facility also has a hospice waiver for six (6) residents. During the visit, there was five (5) residents and two (2) staff present.

LPA conducted a tour of the facility’s interior and exterior and observed the following:

Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. LPA observed the facility met the requirement for a 2-day supply of perishable food and 7-day of non-perishable food items. Cleaning solutions and knives/sharp instruments are secured in a locked kitchen cabinet. Fire extinguisher is charged and mounted on kitchen wall.

Dining and Living room: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition. Facility has six recliner chairs available for the residents. LPA observed residents in their rooms and in common areas.

Hallway : LPA toured the hallway and observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detectors were tested and functioning properly.