Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman and Sabel Martinez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with AM Lead, Danica De La Vega. According to the facility’s license, the facility has a maximum capacity of four clients, of whom all may be ambulatory and two maybe non ambulatory. The facility is approved for delayed egress at all exits.

LPAs 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. 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 client. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 111 degrees F.

No pools or bodies of water on the premises. Per AM Lead Danica De La Vega, 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. First aid kit(s) were complete and readily accessible.

Resident records reviewed had required documentation, staff records reviewed.

An exit interview was conducted with AM Lead, Danica De La Vega, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit.