Facility Evaluation Report

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a one-year-old required visit. LPA Lund met with Caregiver who called the Administrator Maria Suzie Dizon who came a short time later. LPA Lund explained the reason for the visit to the Administrator. Census: 3.

The facility is licensed for a capacity of 6 non-ambulatory residents of which 2 may receive hospice care services. LPA Lund & Administrator Maria Suzie Dizon toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 109.5*F, which is within the required range of 105-120*F. LPA observed fire extinguishers, smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solutions and guides. LPA reviewed 2 staff and 2 resident files and were in compliance.

No deficiencies are being cited during this visit. Exit interview held. A copy of today’s report provided.