Facility Evaluation Report

On 7/20/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Licensee, Delia Ulbata. The facility is licensed for 10 non-ambulatory residents and a hospice waiver capacity of 2. The facility currently provides care for 7 residents. In addition, there is 1 resident that is receiving hospice services and none of which with a diagnosis of dementia.

LPA arrived at the facility and observed appropriate signage for COVID protocols and client personal rights posted. LPA continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 2/7/2023 at the time of visit. The facility has installed new interconnected smoke detectors which were tested and found to be in working order. Carbon monoxide detector located in the hallway was also tested and found to be functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the facility laundry room. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water was measured at faucets accessible to residents and measured between 112.8 and 116.9 degrees F which is within regulation.

LPA reviewed facility files and found liability insurance updated. LPA observed appropriate evacuation map located in the front room of the facility. Fire drills are also conducted every 3 months, are recorded and signed off by staff and residents.