Facility Evaluation Report

Licensing Program Analysts (LPAs) Christine (Dolores) Kabariti and Marcela Yanez arrived unannounced to conduct the facility's annual required - 1 year inspection. LPAs met with Administrator (ADM), Belinda Devano.

During visit, LPAs toured the facility with ADM to include the living room, resident bedrooms, staff bedroom, bathrooms, kitchen, garage, and backyard. There are 5 residents under hospice care.

All fire exit routes were free and clear of obstruction. 4 staff present are fingerprint cleared. 3 out of 4 staff are associated to the facility. 1 out of 4 staff present was fingerprint cleared but was not associated to the facility. During visit, the ADM associated the staff to the facility using Guardian. ADM was advised to ensure all staff are associated to the facility prior to work.

Facility temperature maintained at 72 degrees F. Fire extinguisher last serviced on 06/04/2024. Carbon monoxide detector observed present and operable in the hallway next to the kitchen. Smoke detectors observed throughout the facility. First aid kit observed complete. LPA observed Personal Protective Equipment (PPE) supplies. Emergency lighting such as lanterns and flashlights observed in the facility. Facility is conducting fire drills quarterly and the last drill was completed on 01/03/2025.

5 out of 5 resident bedrooms observed equipped with proper furniture and lighting to include a bed, linens, night stand, and dresser. 4 out of 5 resident's who are under hospice observed with full bed rails. Based on record review, 4 out of 5 residents hospice care plan included the physician order for full bed rails. 2 residents used oxygen. Oxygen in use sign observed posted outside the resident bedrooms. See LIC809-C.