Facility Evaluation Report

Unannounced Annual Licensing visit made out to this facility on 09/11/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Christine Quiruz, at this time. A brief interview was conducted with the facility designated Administrator at this time.

It was learned that this facility was vendorized to be able to accept and retain up to (6) Level 4I residents at any given time.

This facility is licensed to serve up to (6) Ambulatory only residents at any given time.

Current census was 5 residents, of which (4) of them, were out of the facility at their respectable day programs at this time. Tour of this facility was conducted.

A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time.

Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time.

A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times.

Medication cabinet, located in the kitchen cabinet, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated staff members at this time. A review of the facility Medication Administration Record and dispensing log was conducted.

Medication cabinet was observed to be locked and made inaccessible to the residents at this time.

Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents.

A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.