Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 12:17 pm to conduct a 1-year annual visit to the facility above. LPA met Administrator Aurea Alejandro 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 has 4 bedrooms and 2 bathrooms, with 1 bedroom dedicated to staff. The facility occupies 2 residents and employs 3 staff of which one is the Administrator and back-up are available if needed. The facility has smoke and carbon monoxide detectors; both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting.

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 02/28/2027. The facility is approved for a capacity of 6 non-ambulatory of which 1 may be bedridden.

Staffing/Personnel Records & Training: Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed were kept up to date with all requirements. LPA reviewed training records for Annual Training Requirements, all required annual training was documented. Administrator Certificate expires 3/11/28. Continued 809-C