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 Chalongklang Rabiab. Administrator Siera Navasak arrived during the visit.

The facility is licensed for a maximum capacity of 6 non-ambulatory residents and has a waiver for 3 hospice residents. During today’s visit, the facility had a census of 4 residents, 2 of which were non-ambulatory. The Administrator for the facility is Siera Navasak 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 107.8 and 114.4 degrees Fahrenheit in common bathrooms for resident use. The facility’s internal temperature was measured at 76 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Siera Navasak, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The temperatures for the facility refrigerator and freezer were kept within regulatory requirements.