Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with caregiver, Concordia Casabar and stated the purpose of today's visit. LPA Rai observed 3 staff and 4 residents at the facility. LPA Rai spoke with Licensee/Administrator, Leilani Cortes and stated the purpose of today's visit. Facility has an approved waiver for 4 Hospice residents and currently there are 3 residents receiving Hospice services.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

LPA Rai toured the facility to include 5 resident rooms, 1 staff room, living room, dining room, kitchen and laundry room. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 113.0 - 113.9 degrees F.