Facility Evaluation Report

On 5/6/2022 at 10:00 AM, Licensing Program Analyst (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct a Pre-licensing Inspection. Upon arrival, LPAs were greeted by Care Staff, Rodora Suzon. Administrator, Fathma Ansar later arrived at 10:24 AM. The facility's fire clearance was approved for all six residents may be non-ambulatory.

LPAs toured facility with Administrator and Care Staff including but not limited to 6 residents bedrooms, 2 staff rooms, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 107.6 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 11/1/2021.

During record review, LPAs reviewed a sample of 2 residents and 3 staff records. 2 of 2 residents and 3 of 3 staff have current records maintained.

The following were cited and corrected from a Case Management for existing license (#075601511 ):

At 10:30 AM, LPAs observed two knives being stored inside dishwasher accessible to residents. Deficiency cleared during visit. Staff removed both knives and locked it away.

At 10:33 AM, LPAs observed laundry detergent unlocked placed above laundry machines. Deficiency cleared during visit. Staff removed detergents from shelf and locked it away inside a cabinet.