Facility Evaluation Report

Licensing Program Analysts (LPAs) A. Gomez and P. Watson conducted an unannounced 1-year Required visit on this date. LPAs met and toured with Administrator, Ana Breen. The Administrator currently holds a certificate (#6051319740 ) to expire on 2/28/2025 . The facility’s fire clearance was approved for six (6) non-ambulatory residents and subject to three (3) hospice waivers.

LPAs toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six ( 6) total bedrooms which three (3) bedrooms are occupied by the residents and three (3) bedroom is occupied by staff.A comfortable temperature is maintained at 77 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 2-day of perishable foods and a minimum 7-day non-perishable foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/10/2022 . First aid kit was observed to be complete.