Facility Evaluation Report

Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual required visit on 6/16/2023 at 12:20 PM LPA was granted entry and met with Staff Rodrigo Baluyut (Rolly) who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (3) clients present.

Buildings and Grounds: The home is composed of six (6) bedroom, five (5) client bedrooms, one (1) staff bedroom, three (3) bathrooms, a laundry area located in the garage, kitchen and dining area, and a front/back yard area. The interior walkways of the home were observed to be clutter free with no obstruction. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Rolly, there are no weapons stored in the home. Rooms, furniture, beds, mattresses appeared to be in good repair. The bedrooms are furnished, and privacy is available. The dining and living room areas are clutter free and in good condition. The LPA tested the hot water temperature, which was registered at 114.3 degrees Fahrenheit, which is within regulatory limits. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer are available and in working order.

Storage and Supplies : The first aid kit components was observed to be available and complete and found in the hallway closet. Cleaning supplies stored in the bathroom under the sink and locked in cabinets. Linens, and equipment appeared to be in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged.

Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps stored in the kitchen pantry under the sink. Additional knives were found in accessible overhead cabinet near the stove which is not is not in compliance.

Record Review and Resident/Staff Files: LPA reviewed all staff files and reviewed the facility's staff schedule. All staff have criminal clearance. Staff member providing care has all proper documentation. Three (3) client files were reviewed and 2/3 files had resident admission agreements, 1/3 files were missing all residents documents including current physician report.