Facility Evaluation Report

On 5/7/2029 - Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced continuation of the 1 year required visit and was met by 2 staff (S1 and S2).

At 10:01 a.m. - LPA arrived at the facility and observed no cars on the drive way. LPA was greeted by S2 who was outside attending to the front yard and accompanied LPA inside the facility. LPA observed that all residents are not in the facility. S2 stated that residents are attending day program and HM is at the day program with the residents. LPA observed S1 was inside doing housekeeping chores,

S1 attempted to call the house manager(HM) and administrator (ADM). S1 was able to reach ADM and ADM stated that HM will be in the facility within 10 to 15 minutes. S1 stated that he/she does not know which key to use to access facility records.

At 10:45 a.m. HM arrived at the facility. LPA and HM continued with the annual review of the facility's record, resident's record and staff record. LPA reviewed 3 out 5 resident record. 1 out of 3 is missing the consent form, 2 out of 3 personal rights was not signed by the responsible party, 1 out of 3 does not have a weight record. HM stated 1 out of 3 resident refuses to get their weight checked. 1 out of 3 resident is not able to stay to get an accurate reading and sometimes refuses to get weighed in. HM stated that he/she will have the responsible parties signed the personal right forms. HM stated most of the time the responsible party's are always in a hurry, but will make sure that next time they visit the forms are signed and will provide proof to LPA.

LPA and HM reviewed the 3 out of 8 staff record and observed that 1 out of 3 staff was recently hired and is in the process of completing required training. Facility record was reviewed, the fire drill and disaster training is up to date.