Facility Evaluation Report

On 08/05/24 at 12:10 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger and P. Manalo arrived unannounced to do an annual inspection. LPA meet with Josefina Northcutt and explained the purpose of the visit. Sureshkumar Reddy joined us 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. 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. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet cleaning supplies, was observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 05/03/2024.

At 12:20 pm LPA reviewed 4 residents records. At 1:05 pm, LPA reviewed 2 staff records.

The following deficiency was observed during the visit:

R4 has an admissions agreement that is not for this license

The Shed and side yard are full of broken furniture

There is not a staff member who is working with CPR training