Facility Evaluation Report

Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced post licensing visit on 09/07/2022. LPA Pascua was met with Facility Designated Administrator, Christine Quiruz., and explained the purpose of the visit. The purpose of this visit is to conduct a post-licensing visit.

This facility is licensed to served and accept up to 4 residents who are deemed to be ambulatory only. This facility is also vendorized to accept and retain Level 4I residents at this time. Census was currently at 3.

The facility has a main entrance screening point. The facility has Covid-19 posting throughout the facility. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Armor Fire Extinguisher Company 05/19/2022.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional non-perishable food was identified in the additional pantry in the hallway. Additional perishable food was identified in the additional freezer in the garage.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees.

A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time.

LPA Pascua observed a locked centralized stored medication located in the hallway. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.