Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:45 am to conducted a 1 year annual visit to the facility above. LPA met Administrator Guillerma Pacaoan 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 on file with the department. The facility has a sign in and out binder at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. 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. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Administrator will replace trash cans and waste baskets that do not have tight fitting covers.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 02/23/2024. The facility is approved for a capacity of 6 Non- Ambulatory of which 1 may be bedridden in bedroom #1 and a Hospice waiver for 3. The facility is an RCFE approved for dementia residents.

Physical Plant & Environmental Safety: The facility is a 4 bedroom and 2 bathroom currently occupying 5 residents and employs 6 staff. One of the bedrooms is designated for live in staff. LPA was authorized to enter and inspect facility. The facility living room, dining room, bedrooms, and bathrooms were clean, safe, and sanitary The facility has smoke and carbon monoxide detectors. Carbon monoxide was tested and working at the time of the visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. 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 in care locked in cupboards in the bathroom and office. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard and front yard for client use with a patio for shade. The facility has telephone and internet service for resident use. The gates are in need of repair to remain self closing and self latching, Administrator ordered supplies and is having work done to fix the issue. Cont. 809-C