Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 9:45pm to conducted a 1 year annual visit to the facility above. LPA met with Administrator Evelyn Florentino 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 an Infection Control Plan on file. The facility has a sign in and out binder for visitors 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. The staff take infection control training annually.

Physical Plant & Environment Safety: The facility is a 3 bedroom and 2 bathroom home currently occupying 4 residents and 2 full-time staff with 6 relief staff and Administrator. 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. The gates are self closing and self latching. The facility has table and chairs available outside with shaded area for resident use. Laundry room has working washer and dryer.

Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current up to date liability insurance. All Dementia requirements are being met. Hospice wavier granted for 3. The facility has 2 residents on home health services. The facility does not currently have any hospice residents. Facility currently had 1 resident on oxygen, signs are on the front door and bedroom

Personnel Records & Training: The facility keeps confidential files on each staff member. Training records were up to date for 2024-2025 annual training requirements.