Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted a pre-licensing visit to the above noted facility. The LPA met with applicants, Johnna Macanin and Helen Rose T. Busch. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been requested. Component III was completed during the inspection with the applicants.

The facility is a single story home. At 11:50 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing the home for five (5) non-ambulatory residents in rooms #1,#2 and #4, and one (1) bed-ridden resident in room #3. The home has a sprinkler system. The facility has two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 and #3 has direct access outside. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with comfortable mattress and clean linen; which includes, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. The facility does not have a staff room, therefore will have 24 hour awake staff. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is two common restrooms in the hallway and one private restroom in bedroom #2 . The resident bathrooms have showers with non-skid materials. The private restroom has a shower and a bathtub with grab bars and non-skid materials .The hot water temperature was measured in the common bathrooms and ranged between 111.0 F and 113.4 F, within the allowable range of 105*F to 120*F.