Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:04 a.m. to conduct a 1-year annual visit to the facility above. LPA met with Patricia Hernandez and Reyna Espinosa and explained the purpose of the visit.

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

Physical Plant & Environment Safety: The facility is a 4 bedroom and 2 bathrooms. The facility occupies 4 residents and employs 7 staff of which one is the Administrator. The facility is clean, safe and sanitary. The facility has smoke and carbon monoxide detectors which were tested and working properly at time of inspection. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade.

Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 09/15/26. The facility is approved for a capacity of 6 non-ambulatory and approved for hospice waiver of 3.

Staffing, Personnel Records & Training: Staff records are kept confidential. LPA reviewed 5 staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate expires on 01/01/28. All files were kept up to date with all requirements being met. LPA reviewed staff training records for Annual Training Requirements of 20 plus hours additional training was scheduled and will be completed by end of week.