Facility Evaluation Report

On 6/30/2023 starting at 10:00 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Warlita Agmata-Rivac, Administrator (ADM) and explained the purpose of the visit. Administrators certificate (6007524740) expired on 12/17/2021. The facility’s fire clearance was approved for six (6) non- ambulatory residents, which all 6 may be on hospice. Upon entry, LPA observed one (1) staff and two (2) residents present during inspection.

Starting at 10:20 AM, LPA toured facility with ADM including but not limited to six (6) bedrooms, three (3) bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which all 6 bedrooms are private. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in residents’ common area bathroom was measured at 114.3 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supple 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 7/7/2021. First aid kit was observed to be complete.