Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Liza Cruz and Lucy Luo. Administrator Juliane Cruz arrived shortly after LPA, joining halfway through the physical walk through of the home. The facility's license shows a maximum capacity of six (6) residents, where one (1) of which may be bedridden. Bedridden may only reside in bedroom #1. Additionally the facility is approved for six (6) hospice waivers. During today’s inspection there were six (6) residents in care, with three (3) on hospice.

LPA, Caregiver Luo, and Administrator Cruz toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Common bathroom sink by front entryway was 110.1F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care.