Facility Evaluation Report

On 03/03/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit to follow up on the incident report the department received on 02/28/2025. LPA met with Administrator, Adi Lina Tuiloma, and explained the purpose of the visit.

LPA and Administrator discussed the incident which occurred on 02/21/2025 regarding an electrical fire which happened in the hallway bathroom. The fire happened in the evening on 02/21/2025 around 7:30 p.m. There was six (6) residents and one (1) staff present. Staff #1(S1) stated the facility smoke alarms went off. S1 assessed rooms and residents and saw the smoke coming out of the bathroom. S1 was able to put the fire out. Once fire was out S1 called emergency services to come out and assess the area. Local emergency services told the facility to not use the bathroom until the wires were fixed.

On 02/22/2025 the facility did have an electrician come out to assess all the wires in the facility. Administrator stated it was just that one wire and it was fixed the same day as the visit from the electrician. The bathroom is in working condition and residents are able to use it again.

LPA and Administrator discussed that incidents need to be reported to Community Care Licensing (CCL) within 24 hours of occurrence.

As a result of todays visit deficiencies cited.

Exit interview conducted and a copy of the report and appeal rights was left at the facility.