Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 9/23/23 at 2:00PM. The facility is licensed for 4 residents of which 4 maybe bedridden. Hospice waiver approved for 1. LPA met with Amy Lee, Administrator and Claire Ascalon, RN Consultant and stated the purpose of the visit.

LPA observed the P&I monies for R1 that was counted and documented appropriately and not commingled during this visit. There are 0 residents receiving hospice care services during this visit.

Infection Control Plan observed and submitted to Community Care Licensing (CCL).

LPA observed 4 residents participating in individual activities during this visit.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed a posted updated Liability insurance policy.

The most recent emergency drill was July 12, 2023. LPA observed 2-day perishables and 7-day non-perishables.

The temperature inside the facility was observed to be at 77*F which is within the required range of 68-85*F. The hot water temperature was measured at 111.0*F which is within the required range of 105-120*F.

LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the facility has a pull alarm system. LPA observed the centrally stored medications area to be locked and inaccessible to residents.