Facility Evaluation Report

Licensing Program Analyst (LPA) Miller arrived at 9:30 am to conduct a one year annual visit to the facility above. LPA met with Back-Up Administrator, Cheryll Estacio and explained the purpose of the visit.

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

Physical Plant & Environment Safety: The facility has 3 resident bedrooms, 2 bathrooms and currently occupies 3 residents and employs five full time staff and one Administrator. LPA Miller was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. 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 under sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use.

Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on January 7, 2025. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory of which four may be bedridden. Hospice is approved for four.

Staffing: The facility currently employes five full time staff and one Administrator. Staff files were reviewed. LPA observed that one facility staff (S1) was not associated to work in the facility, but had fingerprint clearance prior to working in the facility. Current Administrator Certificate expires June 17, 2024.