Facility Evaluation Report

On January 22, 2025, at 08:50 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the caregiver, Elsa Lopez, and disclosed the purpose of the inspection. The caregiver informed the LPA that the facility had (6) residents in care and (3) staff members present at the time. LPA observed (2) staff members in the kitchen preparing breakfast and (1) staff member assisting residents with the breakfast on the dining table.

At 9:24 AM, the LPA initiated a walk-through of the facility, accompanied by the caregiver.

LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. The LPA observed (5) residents eating breakfast at the dining table.

LPA inspected the living room and observed it clean, with all furniture in good repair. There were reclining chairs and a television in the living room. LPA inspected the fire extinguisher mounted on the wall in the living room and found it fully charged, with the last service tag dated 04/09/2024. The caregiver tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional.

There were (6) bedrooms and (2½) bathrooms designated for residents' use. All resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. LPA observed scissors on a table in room #1 and another scissors on top of chest in room #3, accessible to residents. LPA inspected (2) full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats. The hot water temperature at the sink faucet measured 108.5°F in bathroom #1 and 109.2°F in bathroom #2.