Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required visit of the facility. LPA was welcomed by staff Maria Botelho . Licensee Mary King was contacted by facility staff on the telephone and arrived later during this visit. There is a total of 11 residents, 5 dementia residents. There are 3 residents currently on Hospice.

LPA toured the facility on 2/26/2024 at 8:45 AM with staff, Licensee jointed shortly after; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 2/05/2024 at the time of the visit. Facility smoke detectors were found to be operational on 2/26/2024. LPA observed 2 out of 2 Carbon monoxide detectors that were found to be operational during the visit. There are night lights in many of the common areas, resident’s bedrooms, and bathrooms of the facility. Hot water temperature measured between 113.1 degrees F and 115.8 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 2/26/2024 at 9:15 AM. The facility serves residents with dementia and has a plan of operation for special care and programming. 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. LPA toured the kitchen area on 2/26/2024 at 9:15 AM with staff Maria and observed food stored in the refrigerator is labeled with dates. There are no special dietary needs for residents at the facility on 2/26/2024 at 9:20 AM. Food is available for residents any time of the day. At approximately 9:05 AM on 2/26/2024 LPA & Staff Maria observed unlocked spare medication cupboard containing 2 residents diarrhetic medications (see pic). Licensee immediately locked (see LIC809-D). Toxins are stored in a locked garage room. There was a supply of cleaners, hygiene products and paper products available for residents.