Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 11:25am to conducted a 1 year Annual visit to the facility above. LPA met with Administrator Rachelle Tellez and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. The facility staff have taken annual Infection control and PPE training.

Physical Plant & Environment Safety: The facility is a 6 bedroom and 6 bathroom home currently occupying 6 residents and 7 staff, including 3 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. Laundry room has working washer and dryer.

Operational Requirements: The Facility is operating in compliance with fire clearance. Capacity is 6 with 1 non-ambulatory and 5 bedridden with a hospice waiver for 3. The facility has current liability insurance on file. The facility has dual hard wired smoke and carbon monoxide detectors with sprinkler system.

Staffing: The facility currently employs 7 staff and 3 Administrators. Staff records are kept confidential. The 5 files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Criminal Record clearance or exemption. Administrator Certificate for Roxandra Whitestine Administrator expires 08/30/2027.