Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:00 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Jonelyn San Antonio, back-up administrator 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 fire extinguisher was last charged and inspected on 12/5/24. Trash cans and wastebaskets have tight fitting covers. The facility has 3 client bedrooms and 2 client bathrooms currently occupying 5 clients. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting and lamps are sufficient for the use of the facility and for client comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid flooring. The pathways are clear of any obstructions. 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 client use.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 4 non-Ambulatory. A hospice waiver is approved for 2 clients. The facility currently has 5 ambulatory clients.