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25 | Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 10/311/7/2023 at 11:08 am. LPA was met by Administrator Pavon and explained the purpose of the visit. The facility is licensed to serve six (6) non-ambulatory residents over the age of 60 of which one (1) may be bedridden and has an approved hospice waiver for six (6).
LPA OBSERVATIONS: The facility is a single-story building located in a residential neighborhood with four (4) resident bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage.
Front Yard: Was clean and well maintained. No hazards were observed.
Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in garage, to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 120.2 degrees F. Kitchen appliances were observed to be clean and in working order.
Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting.
Linen Closet: Contained plenty linens, towels, and hygiene products.
Resident Rooms 1 - 4: LPA Ramirez observed all five (5) resident bedrooms to contain required furnishings, lighting, and linens.
SEE 809-C for continuation
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