Facility Evaluation Report

On 05/16/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Representative (FDR), Sarena Arias and explained the purpose of the visit.

This facility is licensed to served 6 residents, all of whom may be non-ambulatory. This facility also has a dementia plan on file and has a current hospice waiver for 6.

Current census was 4. 3 out 4 residents were out at of the facility at this time.

A brief interview with FDR Arias was conducted.

LPA reviewed 4 resident files.LPA reviewed 3 staff files. 3 out of 3 staff files were complete and up to date. Facility Designated Administrator currently holds an active and current administrator certificate #6019506740 and expires on 08/16/2024.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annual inspected by Jorgenson Fire Co and is valid until 09/19/2024.

The kitchen area was toured. LPA observed a sufficient supply of 7 day non-perishable and 2-day perishable food supply in the pantry and refrigerator.

LPA observed a locked centralized stored medication cabinet located in the laundry room. Along with the FDR, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time

A tour of the bathroom was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.