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 Conchita "Connie" Torzar.

The facility is licensed for a maximum capacity of 6 ambulatory residents, 2 of which may be non-ambulatory in bedroom #3 and has a hospice waiver for 4 residents. During today’s visit, the facility had a census of 6 non-ambulatory residents. Review of documents submitted to the Department received a request for fire clearance increase on 8/28/2024 and that request is pending. The listed Administrator for the facility is Almina Street, whose certificate expired on 11/8/2023. However, interviews with staff revealed that the current Administrator is Rafael Gamab, and their certificate is valid and current.

During today’s visit, LPA inspected each room of the facility, including resident rooms, common and private bathrooms, kitchen, garage, common areas, and outside space. No bodies of water, delayed egress, or secured perimeters were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s ambient and water temperature were measured within regulatory requirements at multiple locations. LPA observed locked storage for resident medications which were stored separately from food supplies. LPA observed that the locking mechanisms on the dangerous/ hazardous item storage in the kitchen and laundry room were in disrepair, resulting in one of the two cabinet doors being unlocked. Staff repaired the locking mechanisms during the visit and re-secured the locked storage. According to "Connie" Torzar, no firearms or weapons are stored on the premises. LPA observed a minimum supply of 2-days of perishable food and 7-days of non-perishable food.