Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:30 am to conducted a 1 year annual visit to the facility above. LPA met with Licensee/Administrator Janelyn Castaniaga 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 a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, hand dryer, hand soap, and hand washing signs and paper towels. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms when and if needed. All trash cans and waste baskets have tight fitting covers.

Operational Requirements: The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance effective 05/01/2024. The facility is approved for a capacity of 6 Non-Ambulatory and a Hospice waiver approved for 4.

Physical Plant & Environmental Safety: The facility is a 5 bedroom home with 3 double rooms dedicated for residents. The facility has 3 bathrooms to be used by residents and 1 staff bathroom currently occupying 2 residents and employs 2 staff and 2 administrators. The facility has 2 bedrooms for live-in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The kitchen has a gate to make the range inaccessible to dementia residents, and it does not lock. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents are locked in the laundry room and locked garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for resident use with furniture and plenty of shade. Telephone and internet service is provided for resident use. The facility has a working washer and dryer. Continued 809-C