Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by staff Glenda Castle. Georgiana R Santos Licensee/Administrator was contacted by facility staff on the telephone and wasn’t able to be present for this visit, LPA spoke with Licensee authorizing staff to sign documents. There is a total of six residents, 4 with diagnosis of dementia, 1 resident on hospice.

Facility tour/inspection began at 8:45AM:

LPA toured the facility with staff Evangeline; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices that were working properly during the visit. The one Fire Extinguisher was found to be last charged on 1/24/2022 at the time of the visit out of Title 22 regulations (see LIC809-D). Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured 107.7 degrees F and 108.6 degrees F in 2 out of 2 resident bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. 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 food 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; although cleaning supplies were stored under kitchen sink with food (see pic & LIC809-D) and were removed by staff. At approximately 9:00am LPA observed in kitchen with staff, broken lock on knife/sharps drawer which is a danger to residents in care (see pic & LIC809-D). Toxins are stored in the garage in a locked laundry cabinet; although on 1/3/2023 at 9:20am LPA observed cleaning supplies w bleach on floor in garage & laundry detergent in uncovered cup in resident bathroom at 9:30am in unlocked cabinet under sink (see pic & LIC809-D) both removed by staff. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings.