Facility Evaluation Report

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with administrator, Lilibeth Grabowski. The LPA informed the Administrator of the purpose for the visit. The inspection included the following:

LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of four (4) resident bedrooms, one (1) staff room, three (3) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry area, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 111.3 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home. LPA observed a pool in the backyard with the required fencing and locked gate.

LPA began review of client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA recommended that 4 residents with Dementia have their LIC602 Physicians Report updated due to being assessed longer than 12 months. LPA observed client records to be available and complete.