Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lilia Rena.

According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation and review of each resident’s latest LIC602 Physician’s Report: During today’s visit, there were a total of three (3) clients in care, and none were bedridden. This facility’s license does not include endorsements for secured perimeter or delayed egress doors, and none of these were present during the visit.

During today’s visit, LPA interviewed multiple staff and residents. LPA reviewed all staff and resident records/files. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in general good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 73 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 111.1 F, Bathroom #1 Sink was 111.6 F, and Bathroom #2 Sink was 112.1 F. Appliances to preserve perishable food were also compliant in temperature: Kitchen Refrigerator was 31 F and Kitchen Freezer was 0 F. Garage Refrigerator was 39 F and Garage Freezers were 0 F and 0 F, respectively. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present.