Facility Evaluation Report

Announced Annual visit made out to this facility on 11/27/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Pedro Pancho, at this time. A brief interview was conducted with the facility designated Administrator at this time.

It was learned that this facility was licensed for a total of (6) residents, of which, all (6) could be nonambulatory. This facility is licensed to be able to retain (1) bedridden resident with a hospice waiver approved for (6) residents.

There was (1) resident under the care of hospice at this time according to statements made by the facility designated Administrator.

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 facility entry way, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator 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.