Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's post-licensing inspection. LPA met with Program Manager (PM), Jose Rodriguez.

Upon entrance, LPA signed in at the front desk. Posters were observed to include if you see something say something and personal rights. Facility license posted in a visible area. LPA toured the facility with PM to include 7 out of 12 bedrooms, common area, bathrooms, office spaces, storage closets, IT room, group room, staff break room, dining room, medication room, and kitchen. All exit routes were free and clear of obstruction. Sharp objects, medications, chemicals, and disinfectants observed in a locked space. All staff members present are fingerprint cleared and associated to the facility. Residents observed participating in activities.

Facility temperature maintained between 70 - 73 degrees Fahrenheit. Resident bedrooms observed with beds, linens, adequate lighting, desk, chair, and closet. Trash-can with lids observed in each bedroom. Women and Men's hot water temperature maintained between 105 - 108 degrees Fahrenheit. Facility has a sufficient supply of extra linens.

Facility refrigerators temperature maintained at 36 degrees Fahrenheit. Freezer temperature maintained at 0 degrees Fahrenheit. LPA observed at least 2 days worth of perishables and 7 days worth of non-perishables. Daily meal times posted throughout the facility.

LPA reviewed 4 resident files were maintained to include a medical assessment, TB result, appraisal/needs and services plan, safeguard of personal property and valuables, admission agreement, personal rights, and consent forms. SEE LIC809-C.