Facility Evaluation Report

On 10/23/24 at 10:20 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with staff and explained the purpose of the visit. Administrator Ann Oglobosele was called and joined later.

LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks.Outdoor activity space was observed furnished with tables, chairs and shade.

At 10:45 am LPA reviewed 3 residents records. At 12:05 pm, LPA reviewed 3 staff records and 3 of 3 were fingerprint cleared and associated to the facility.

The following forms to be updated and submitted to CCLD by 10/30/2024:

LIC 308 Designation of Administrative Responsibility

The following deficiency was observed during the visit:

3/3 residents are missing or need updated needs and services plans

2/3 residents are missing medical assessments

3/3 residents do not have a signed LIC 405 property and valuables

Facility is not storing the residents cash at the facility

Exit interview conducted with Program Director. Appeal Rights and a copy of this report provided