Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff , S1, Leticia Antonio . S1 contacted Facility ADM. ADM stated he could not come to the facility due to a family emergency. ADM stated S1 could sign on his behalf. During the visit, LPA observed 1 residents and 2 staff. LPA explained the purpose of the visit.

LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 112 degrees F in both resident bathrooms.

During the tour of the facility, LPA observed several physical plant issues. LPA observed a rusty shower curtain rod in the facility hallway bathroom closest to the kitchen. (Photograph was taken.) LPA also pointed out the plastic flooring/base at the shower is beginning to degrade, resulting in the black spots. LPA also noted stains on the shower walls and at the base of the shower. While touring the resident bedroom closest to the backyard shed, LPA observed a hole in the door. (Photograph was taken.) While touring the backyard, LPA observed two of the wooden planks of the fence, next to the storage shed, were no longer attached to the fence, creating an opening. Page 1 Out of 2.