Facility Evaluation Report

Licensing Program Analyst (LPA) Melisa Rankin arrived at 10:12 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator, Gerardo Sanchez 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 facility has 4 resident bedrooms, 3 Staff bedrooms and 2.5 bathrooms. Facility currently occupies 3 residents and employs 2 full time staff and 1 one back up staff. 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 secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care locked under sink, in garage or locked in outdoor sheds. 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.

Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on 8/30/26. The facility is approved for a capacity of 6.

Record Review: Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results. Administrator’s Certificates expire 1/25/27.

Resident Records: Facility does submit incident reports to the department when required. LPA reviewed 3 resident files and 1 past resident records for signed Admission Agreements, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, and Emergency and ID forms. Continued 809-C