Facility Evaluation Report

On 4/29/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Continuation visit to facility. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by Administrator, Jean Asignacion.

All residents present during today's inspection. Facility observed to be clean, well lit, and a comfortable temperature. Resident bedrooms toured, resident's room observed to have required furnishings available. Resident bathroom toured, fixtures observed operational, tub/shower observed to have grab bars, skid resistant mat and shower chair available. All common areas of facility have adequate seating available for residents. Kitchen toured, LPA observed facility to have a 7-day supply of non-perishable food available and a 2-day supply of perishable food. Medications observed to be locked and secured in kitchen cabinet. All medications observed to original labels and to be administered as prescribed. Staff and resident files reviewed. Inspection tool completed.

During interview with Administrator it was stated that R1 had been hospitalized due to fall, however LPA was told that an incident report had not been submitted to Department

Outside of facility toured. No hazards observed.

LPA received copies of Administrator Certificate, Liability insurance and Infection Control Plan during inspection.

Deficiency cited on the attached 809-D. .

Exit interview conducted. A copy of report provided to staff for facility records.