Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi conducted a Pre-licensing visit to the above facility. LPA met with Administrator Monica Vigil and explained the reason for the visit.

At 10:00am LPA conducted physical plant along with Administrator. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. Smoke detectors and Carbon Monoxide detectors appeared to function properly during time of visit.

Facility is a single-story residence and consists of a total of five (5) bedrooms and two (2) bathrooms with (1) bedroom is designated for staff use at this time. Fire clearance was approved for (6) non-ambulatory residents, but licensee stated since they are residing in bedroom #2 at this time they will be updating facility capacity from (6) to (4). Fire extinguishers were observed to be fully charged and purchased this year . During physical plant tour LPA observed the required postings throughout the facility.

Kitchen: The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are to be stored in a locked cabinet in the kitchen next to the hallway. Medications are planned to be kept in this cabinet in individual medication lock boxes. LPA observed PPE supplies stored in this cabinet and appeared sufficient at this time. Cleaning supplies and toxins will be kept in a locked cabinet to the right of the sink. To the right of the kitchen was in office area. Dining furniture in kitchen and dining room area appeared to be clean and sufficient at this time.