Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at approximately 8:50 A.M. When the LPA arrived, there were two (2) staff members and five (5) residents present. The LPA was greeted by Caregiver, Ralph Renz Del Rosario and Jonie May Del Rosario. LPA informed the reason for the visit. Administrator was unavailable during today's visit, however caregivers are authorized to sign today’s report. Entrance Interview.

Beginning at 9:15 A.M., the LPA, along with caregiver toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The following was observed:

KITCHEN : Kitchen appliances appeared to be in operable condition. At 9:22 A.M. hot water measured at 118.3 degrees. Cleaning supplies and knives were stored in a locked cabinet under the kitchen sink. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on some product labels.

BEDROOMS: There are five (5) bedrooms in total, of which two (2) are private rooms, two (2) are designated for shared resident use and one (1) is a staff room. All bedrooms observed were furnished and contained beds, chairs, bedside tables and lamps. All beds have appropriate linens.