Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Leonor Gaya. LPA spoke with House Manager Lauren DeLancy via telephone during the visit.

The facility is licensed for a maximum capacity of 6 residents, 5 of which may be non-ambulatory. As of 3/14/2024, the facility has a pending fire clearance request to increase the facility's capacity to 6 non-ambulatory residents, 1 of which may be bedridden. The facility also has a pending waiver request for 4 hospice residents. During today’s visit, the facility had a census of 5 non-ambulatory residents. The Administrator for the facility is Rafael Gamab and their certificate was valid and current.

During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 107.6 and 107.8 degrees Fahrenheit in common bathrooms. The facility’s internal temperature was measured at 78 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for resident medications and resident and staff files. During the review of the locked medication cabinet, LPA observed the daily medications for all 5 residents were stored in a daily pill box. Interviews with staff revealed that the pill boxes only contained medications for that day.