Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required 1-Year inspection visit. LPA met with the Administrator, Michelle Benitez and stated purpose the visit.

The facility is licensed to serve adults 60 and over, 6 ambulatory and 6 out of 6 may be non-ambulatory and a hospice waiver for 5. The facility has a current census of 5. At the time of the visit (0800), one staff and administrator was busy assisting resident with their activities of daily living (ADLs). LPA was accompanied by the administrator during inspection of the facility inside and outside.

LPA observed exterior walkways were free from any obstruction ramps and railings. The back ramp was observed to have some signs of wear and tear. A gazebo was observed and items were stored in the gazebo, such as tables, propane gas tanks, cat scratchers, some chemicals on the table, cat food on the table, some gardening tools to name a few. LPA observed a sack of plant food/fertilizer. ADM stated the gazebo is not used by residents during winter season. In the summer time, the gazebo is cleaned and de-cluttered for resident's use.

LPA inspected the garage and laundry area, found the laundry area unlocked. Laundry detergents were observed on top of the shelves above the washer and dryer. Washer and dryer were in good working condition. The garage was organized and has a walkway that was not obstructed.

LPA inspected the interior of the facility and observed that hallways were free from obstruction and free from tripping hazard. The hallways were well lighted. 5 out of 5 resident bedrooms are sanitary and organized, furnished with dressers, chairs and tables that are sufficient to store resident's personal belongings. LPA observed that 5 Out of 5 residents are non-ambulatory, at the time of the visit 2 Out of 5 residents were awake and 3 Out of 5 were in bed resting. page 1 of 3 - continued to LIC 809 C