Facility Evaluation Report

On 3/30/2023 starting at 9:35 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a 1-Year Annual Required Inspection. LPA met with Olive Lyn Neri- Administrator (ADM) and explained the purpose of the visit. The facility’s fire clearance is approved for all six (6) non-ambulatory residents. Upon entry, LPA observed three (3) staff and six (6) residents present during inspection.

Starting at 10:00 AM, LPA toured facility with ADM including but not limited to four (4) bedrooms, two (2) bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are private and 1 bedroom is shared. 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 residents'. The hot water temperature in common area bathroom was measured at 119.3 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins 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 7/20/2022. First aid kit was observed to be complete.

During record review, LPA observed facility has a copy of Infection Control Plan and Emergency Disaster Plan on file.

Starting At 11:20 AM, LPA reviewed 4 of 4 staff records. At 12:10 PM, LPA reviewed 5 of 5 residents' records. At 1:25 PM, LPA reviewed a sample of 5 of 5 residents' medication.