Facility Evaluation Report

Licensing Program Analyst (LPA) JoAnn Rosales conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Jocelyn Cacal. This is a change of ownership application. A dementia program was included in the plan of operation. A Hospice Waiver for 4 has been approved. Component III was conducted in conjunction with this pre-licensing visit.

The facility is a one story. A physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for 6 non-ambulatory residents of which 1 may be bedridden. The facility has 4 private resident bedrooms, Rooms #1, 2, 3, and 4 and 1 shared room, Room #5. Rooms #1 and 5 have direct exits to the outside. Room #1 is an approved bedridden room. The facility does not have fire sprinklers. 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, and blankets. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There is 1 staff room. All rooms were free of odors. All window screens were clean and maintained in good repair. There are 2 staff bathrooms in the hallway. Their are 2 resident bathrooms with showers and non-skid mats. The toilets and showers have grab bars. The facility has 2 water heaters and the hot water tested in the resident bathrooms at 119 and 108.4 degrees F. which falls within the allowable range of 105 degrees F to 120 degrees F.

Resident and staff records are stored in locked cabinets in the family room. Medications are centrally stored in a locked filing cabinet in the office. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a hallway cabinet inaccessible to residents.