Facility Evaluation Report

At 9:02am on 12/09/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Care Giver, Francisco Tiburcio, (S1) announced who he is and the reason for the visit. S1 called Licensee/Administrator and received verbal and video conference authorization from Licensee/Administrator to conduct full annual with S1 due to unavailability of Licensee/Administrator.

S1 and LPA conducted a physical tour of this facility which is a 6 resident bedrooms and 3 resident bathrooms down stairs. There are 4 resident bedrooms and two resident bathrooms in the back hall of the facility and 2 resident bedrooms and 1 resident bathroom on the west side of the facility. LPA toured the entire facility and found the smoke detectors to be in all rooms and functioning and the carbon monoxide detector to be in the back hallway and functioning properly. Fire extinguisher was currently tagged and in the green pressure range. All exits and walkways were free and clear of debit. LPA observed at least 2 days of perishable foods and at least 7 days of non-perishable foods on hand for five residents and staff. LPA observed all rooms to have furnishings, linins, and lighting required by regulation. LPA observed facility has a complete first aide kit. LPA noted that the upstairs has a baby gate at the base of the stairs and there an additional 4 bedrooms and 2 bathroom which are all staff bedrooms and bathrooms.

LPA conducted a full inspection of resident and staff files. LPA noted that resident files are updated and complete and all staff files are completed with current CPR and 20 hours of annual training with 8 hours of dementia training for each staff file reviewed. LPA conducted a sample medication audit. LPA noted that the review of the centrally stored medication record did not reveal any violations or citations.