Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 8:32 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator Jovilito Gagarin and explained the purpose of the visit.

Upon arrival 2 staff were noted as being present as well as two nurses conducting visits. Residents were eating or being assisted in the living room area. Around 9:12 am a tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility has 4 resident bedrooms, 2 bathrooms and currently occupies 4 residents with 2 live in staff. The facility has smoke and carbon monoxide detectors that were tested and working properly during the visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked under sink and in the laundry room. The facility has a fenced backyard for client use with plenty of shade. The fire extinguishers were charged and last inspected in November of 2024.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance which expires on 1/17/2025. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory. Recent hospice increase is approved for 5.