Facility Evaluation Report

Licensing Program Analyst (LPA) Melisa Rankin arrived at 8:52 a.m. to conduct a 1-year required annual visit. LPA met with Jeosela Dizon, Administrator. 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: LPA toured resident rooms and observed that rooms were tidy, free of odor, and the lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats/flooring. The indoor pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care and locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for residents’ use. The facility has smoke and carbon monoxide detectors that were tested and operational.

Operational Requirements: The facility has a current plan of operation on file with the department. LPA will review fire clearance within stated records. A staff room noted on the fire clearance is now used as a clients room, the room has a sliding door. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. Hospice waiver is approved for 4 residents. There is currently 1 hospice resident.

Personnel Records & Training: The facility currently employs 2 full-time staff, 5 on-call staff, and 1 administrator. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Continued on 809-C