Facility Evaluation Report

Licensing Program Analyst (LPA) Melisa Rankin arrived at 10:27 a.m. to conduct a 1-year required annual visit. LPA met with Jerry Pineda, Administrator.

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: LPA toured resident rooms and observed that rooms were tidy and free of odor. 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 secure grab bars are present. The showers have slip resistant flooring. Disinfectant and cleaning solutions are locked in a cupboard in the garage. 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 resident use. The facility has smoke and carbon monoxide detectors that were tested.

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 has current liability insurance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory of which 1 may be bedridden. Hospice waiver approved for 1 resident. The facility currently has 1 ambulatory and 5 non-ambulatory residents.