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 Administrator Melissa Deussen and caregiver Rosita Soriano. The facility's license shows a maximum capacity of six (6) residents, two (2) of which may be ambulatory, two (2) non-ambulatory, and two (2) bedridden. Bedroom #2 approved for bedridden only, per the fire clearance. However, the license indicates another room (#1) as approved for bedridden, but this is not reflected in the fire clearance. LPA will send out an updated license to reflect the correct license comments. Additionally, the facility is approved for a hospice waiver for four (4). During today’s inspection there were two (2) residents in care, with none receiving hospice services.

LPA and Administrator Deussen 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 non-compliant: A private bathroom sink on the 2nd floor was 135F and a common restroom sink on the 1st floor was 130.5F. Administrator Deussen adjusted the home's water heaters and water temperatures came down under 120F. Licensee will be having a handy-man come take a look at the water heaters to adjust further and ensure water temperatures are in compliant range moving forward. One Type A citation was issued for the hot water temperatures being above the compliant range of 105-120F, and details are noted on the attached LIC 809D page. Administrator Deussen stated that staff always assist residents for toileting and bathing and check water temperatures prior to starting.