Facility Evaluation Report

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Staff Armando Ramirez. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom two (2) may be bedridden. Hospice waiver for three (3). During today’s inspection there were fiveaq (5) residents in care.

LPA with Staff Ramirez toured the interior and exterior of the facility and inspected each room. LPA observed the exterior perimeter gate to be locked with a padlock. Records review revealed that the facility does not maintain a fire clearance approval for locked exterior doors or perimeter fence gates. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Staff Ramirez, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA reviewed facility records. Review of facility records revealed that the facility did not have documentation of required quarterly drills. Confidential records were stored in locked areas.