Facility Evaluation Report

On 10/12/2022 at 10:15am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual infection control visit. LPA Pascua was greeted by staff member, Antonieta Gimeno and was asked to call the Licensee, Marinela Placintar to let her know that licensing was present at this time. Upon arrival the LPA observed a centralized screening point equipped with hand sanitizer and masks. Shortly after, LPA Pascua met with Licensee Placintar explained the purpose of the visit. The purpose of the visit is to conduct an annual infection control visit. This facility has a hospice waiver for 2 and a dementia program on file. There was one other staff member present in the facility at this time, Damian Campbell.

At around 10:30am LPA Pascua initiated a tour of the facility with Licensee Placintar.

At 10:35am, LPA Pascua toured resident bedroom #1. Resident furniture was observed to be sufficient to meet their needs at this time. LPA Pascua also toured a bathroom connected to resident bedroom #1. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.

At 10:40am, LPA Pascua toured the kitchen area. L PA Pascua observed a sufficient amount of 2-day

perishable food supply in the refrigerator and a 7-day non-perishable food supply in the pantry for 5 residents. Knives were observed to be locked and made inaccessible to the residents at this time. Cleaning supplies were also observed to be locked under the kitchen sink and made inaccessible to the residents in care. A fire extinguisher was also observed to be in the kitchen and was annually inspected by Jorgenson Co on 03/18/2022.

From 10:45-10:55am, LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the staff member, Antonieta Gimeno, the LPAs observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components.