Facility Evaluation Report

Licensing Program Analyst (LPA) Melisa Rankin arrived at 01:05 pm to conduct a 1-year annual visit. LPA met with Leilanie Acosta Vea 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 resident bedrooms, and 3 bathrooms,. The facility is occupying five (5) residents and employs two (2) staff of which one is the Administrator and one (1) back-up staff. 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, one is being replaced. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The showers have non-skid flooring. 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. 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. The backyard has 2 sheds which are secured. The facility has telephone and internet service for resident use.

Operational Requirements: The Facility is operating in compliance with the granted fire clearance and facility sketch. The facility has current liability insurance which expires on 05/17/2027. The facility is approved for a capacity of 5 non-ambulatory and approved for hospice waiver of 1.

Staffing, Personnel Records & Training: LPA reviewed two (2) staff files. Files reviewed for current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results. Administrator Certificate expires on 12/03/27. All files were kept up to date with all requirements being met. LPA reviewed two (2) staff training records for Annual Training Requirements of 20 plus hours.