Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 2:50pm to conducted a Case Management Annual Continuation visit to the facility above. LPA met with Administrator Nereida Leal and explained the purpose of the visit.

LPA returned to the facility to complete the annual visit with staff files, staff training, and residents files.

Staffing: LPA reviewed 5 staff files for Applications, Finger print clearances or exemptions, Health Screening with TB results. All files were up to date with all required forms.

Pers onnel Records & Training: LPA reviewed 5 staff files for valid 1st Aid & CPR, Infection Control Training, PPE Training and Annual required training. All staff files reviewed had required annual training.

Clients Records & Incident Reports: LPA reviewed 5 Resident files for Signed Admission Agreements, ID and emergency information form, Medical Assessments with TB results, Consent forms, Appraisal Needs and Services Plan (ANS), Personal Rights, Safeguard for Property & Valuables, Safeguard for Cash Resources and Current Surety Bond. Incident Reports are sent to CCL on residents when required. All files reviewed were up to date with all required forms.

Health Related Services: Facility provides first aid to residents when needed. Facility provides or assists in providing transportation to medical and dental appointments, when needed. Facility centrally stores medication for all residents in care. The facility uses the Medication Administration Record (MAR) and the Centrally Stored Medication and Destruct Record (CSMDR).

Incidental Medical Services : Medication were audited, no expired medications, no labels altered, and medications are stored in original containers.

LPA will conduct interviews with 2 staff and residents were out in the community or unable to interview.

Exit interview conducted and copy of report printed for Administrator.