Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with administrator (ADM) Elizabeth Bautista and stated the purpose of the visit.

The facility is licensed to serve adults 60 and over; approved for 6 non-ambulatory, 1 maybe bedridden in room #2 and hospice waiver for 4. LPA observed residents and staff present, 6 out 6 residents were in their room resting. 5 out of 6 are non-ambulatory and 1 out of 6 is ambulatory.

LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 123.1°F. Bathroom water temperature measured at 120°F. A technical assistance was provided to ADM for the kitchen hot water temperature. LPA inspected the refrigerator and the temperature gauge inside the refrigerator reads at 40° F. The freezer temperature is at 0°F.

Medications were locked and inaccessible to residents. However, staff has pre-poured medication in an unlocked drawer for each resident to be given at a later time of the day. LPA observed medication were in a clear covered plastic container with residents name and AM/PM schedule.

LPA inspected the interior of the facility and observed the following. The facility has a total of 4 bedrooms, 2 out of 4 bedroom are single occupancy and 2 out of 4 are shared. Bathrooms had grab bars and non-skid mats. Resident's have storage that are sufficient to store personal items. page 1 of 2