Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio 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 has been requested.

The facility is one story. At 09:06 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for three (3) non-ambulatory residents; and, one (1) of bedridden residents. The bedridden room is in Room #1. The facility has 2 bedrooms, both are shared bedrooms,. All resident rooms have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) 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 a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms – ‘awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is 1 bathrooms in the hallway. T he resident bathroom has a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the bathroom and the kitchen and was found to be within the range of 105*F and 120*F .

Resident and staff records are stored in a locked filing cabin which is currently located in another section of the property. Medications are centrally stored in a locked closet in the living room. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a hallway closet.