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25 | Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA Domingo was welcomed by, identified herself to, and discussed the purpose of the visit with Genovea Guerrero.
According to the facility’s license, the facility has a maximum capacity of thirty (30) residents. During today’s inspection, there were a total of twenty nine (29) residents in care. The facility is licensed to serve 30 residents, ages 60 years and over, all of whom may be non-ambulatory and five (5) of whom may be bedridden. A hospice waiver for eight (8) residents has been approved. The facility currently has six (6) resident receiving hospice care.
LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 71 degrees F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 113 degrees F, Bathroom #1 sink was 113 degrees F, and Bathroom #2 sink was 113 degrees F.
Refrigerator temperature was 40 F and freezer temperature was -2 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.
[CONTINUED ON LIC 809C]
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