Facility Evaluation Report

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct one year annual/required visit. LPA Lund met with Administrator Genaro Baisac and explained the reason for the visit. Census: 3

LPA Lund and Administrator Genaro Baisac tour/inspected the facility. LPA inspected the dining area, living area, and all other areas for resident use. LPA observed to be furnished and maintained in compliance at this time. The Facility had a Medication cabinet (locked) and reviewed and in compliance. First aid kit was observed in the medication cabinet to be present and contained all required components at this time.

A tour of the (3) resident bedrooms, was conducted all three rooms will be shared. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The facility also had one bathroom for the residents. The facility has two rooms for staff use. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time.

The facility has a swimming pool which is locked. The facility has two fire extinguishers that and carbon monoxide are in compliance. The has a working telephone. LPA Lund reviewed two staff & two residents files are in compliance.

No deficiencies were cited at this time and copy of report given.