Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with facility administrator, Flordeliza “Baby” Hipolito, and explained the reason for today’s visit. At approx 10:10 A.M. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This facility is a two-story building. On the ground floor, this facility has twelve (12) rooms and two full and three half (2 full and 3 ½) bathrooms. The second floor contains eight (8) rooms and two and a one half (2 full and 1 ½) bathrooms. This facility doesn’t have a staff room, facility will provide 24/7 care. The following was observed. At approx 10:30 a.m. LPA observed staff conducting activities with multiple residents. LPA observed (12) randomly selected resident bedrooms, each room was observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in several restrooms between 105 - 120 degrees Fahrenheit. In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating areas and dining room furniture were observed to be in good condition. The LPA observed the required postings in the common hallway. The temperature inside the facility was maintained at a comfortable level throughout today's visit. Pantry is located on the 2nd floor. LPA observed a sufficient supply of non-perishable food properly stored. LPA observed cameras in the common areas. No audio is recorded. A working telephone is present. There is an activity area with sufficient space for resident use. LPA observed additional fridges, freezer and cabinets. LPA observed a sufficient supply of additional perishable food, PPE, decorations, and various supplies for facility use all inaccessible to residents in care. LPA inspected the kitchen/food service area.

Kitchen was observed to be inaccessible to residents in care.