Facility Evaluation Report

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Linda Cruz. Caregiver Rose Earlywine later joined the visit. According to the facility’s license, the facility has a maximum capacity of eight(8) residents, of whom all may be non-ambulatory and six(6) may be bedridden. The facility also has an approved hospice waiver for six(6) residents.

LPA, accompanied by caregiver Rose Earlywine, toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Hot water a taps accessible to residents were compliant. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas.

No pool or body of water was present. Per Linda, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present and services within the last twelve(12) months. First aid kit(s) were complete and readily accessible.

Resident records reviewed had required documentation. Staff records contained the required documents.