Facility Evaluation Report

On 11/18/2024 at 12:12 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a Staff #2 (S2) and was granted entry to the facility. At the time of the visit there was one (1) staff present, and five (5) residents present. Licensee/Administrator Michelle Matamoros was contacted and informed of the visit. Licensee/Administrator Matamoros arrived during the visit. LPA Brown explained the purpose of the visit to LIcensee/Administrator Matamoros.

The facility is a five (5) bedroom, two (2) bathroom home with a kitchen, dining area, living room, and an attached garage. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and two (2) resident may be bedridden. The facility's approved for four (4) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Licensee/Administrator Matamoros and S2 to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the residents/staffs shared bathroom to be at 113.9 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws and the disaster plan were posted in a common area. Cleaning supplies, toxins were kept inaccessible to residents in care. There was a designated storage space for resident/staff files.***Continuation in LIC809C***