Facility Evaluation Report

q1On 4/25/2023 starting at 1:10 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with care staff and and explained the purpose of the visit. Administrators certificate (6006422740) is valid and expires on 8/2/2023. The facility’s fire clearance was approved for all six (6) non- ambulatory residents, which facility is granted for two (2) hospice waivers. Upon entry, LPA observed two (2) staff and four (4) residents present during inspection. At 11:02 AM, LPA met and was greeted by Mirriam Paras- Administrator (ADM).

Starting at 10:35 AM, LPA toured facility with care staff including but not limited to six (6) bedrooms, two (2) bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which all 5 bedrooms are private and one bedroom is a staff room. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients'. The hot water temperature in residents ’ common area bathroom was measured at 119.6 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Sharps were locked and inaccessible to residents'.

Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was observed last serviced on 4/4/2019. First aid kit was observed to be complete.