Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 1/3/2024 at 2:00pm.

LPA met with Cheenei Sidney, Caregiver who contacted the Administrator Matthew Enriquez regarding the purpose of todays visit. Matthew Enriquez, Adm arrived within 15 minutes to assist with todays visit. The facility is licensed for a capacity of 6 residents of which 5 maybe non-ambulatory and 1 maybe bedridden.

LPA 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. Administrator Certificate expires 7/2/2025.

The temperature inside the facility was observed to be at 71*F which is within the required range of 68-85*F. The hot water temperature was measured at 116.7*F which is within the required range of 105-120*F. LPA observed pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the P&I monies for Resident #1 (R1) to be counted, documented and not commingled during this visit. The most recent emergency drill was conducted on 12/7/23.

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 solution and guide. LPA reviewed 2 staff and 2 resident files and conducted interviews during this visit.