Facility Evaluation Report

At approximately 10:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a required 1-year annual inspection and were greeted by Mary Ann Ordono, Caregiver/Designated Responsible Party (DPR). Charmaine Mendaros, Administrator was contacted via telephone, gave LPAs permission to begin inspection with DRP, and Administrator arrived approximately one (1) hour later at 11:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for five (5), a bedridden waiver for one (1), is approved for all non-ambulatory residents, and currently has three (3) hospice residents in care.

At approximately 10:50 AM, LPAs initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPAs observed a lock installed near the top of the front door of the facility and advised Administrator to ensure that all facility exterior doors remain in compliance with regulation for a facility not approved for a secured perimeter unless otherwise approved by The Department, (see LIC809D). Administrator removed the lock immediately. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens and hygiene, paper and incontinent care products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. LPAs observed mouse droppings in the food pantry and an activated mouse trap in resident bedroom 3, (see LIC809D). Cabinets containing cleaning supplies and other items that could pose a risk were locked. However, LPAs observed the key used to unlock said cabinets hanging on a hook in the kitchen where accessible to residents in care, (see LIC809D). Facility has at least two days of perishable food and an emergency water supply.