Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a required - 1 year visit on 3/29/24 at 4:00pm and met with Mavictoria Agra, Caregiver who notified Administrator regarding the purpose of the visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 1 maybe bedridden. Licensing fees are due 3/30/24 Pin number provided as option to pay online. Administrator certificate expires 2/16/24 which is in pending status. Most recent emergency/disaster drill was conducted on 3/22/24.

LPA and Mavictoria Agra, Caregiver toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed there are residents participating in activities during this visit. LPA observed the kitchen area, activity areas, bathrooms, storage areas, and laundry rooms. LPA observed knives/sharps areas to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature measured at 114.8*F which is within the required range of 105-120*F. The temperature inside the facility measured at 72*F which is within the required range of 68-85*F.

The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed centrally stored medications area to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) and pull alarm system in the facility. LPA observed 1 client and 1 staff files and conducted interviews during this visit. Facility has central heating and air. LPA observed area where the resident files are locked and readily available for review.