Facility Evaluation Report

On 10/06/2023 at 09:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for a Case Management visit concerning the request by Licensee to increase the capacity from 6 to 7 residents. LPA stated the purpose of the visit to Caregiver Michelle Boyer upon entering the facility. Licensee Kamilla DiStefano arrived at approximately 10:30 AM.

LPA reviewed the floor plan facility sketch during his tour of the facility inside and outside. The sketch is inaccurate and it will need to be rewritten and pass re-inspection by LPA before submission to the Fire Marshall to complete a new Fire Safety Inspection.

3 Type-B citations issued during inspection (refer to LIC809-D for details).

Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided via email.