Facility Evaluation Report

At approximately 11:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Cheryl Gambonini, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, all of whom were present during today's inspection. Facility is approved for six (6) residents, has a Dementia Care Plan, a Hospice waiver for three (3), and is approved for all non-ambulatory residents,.

At approximately 11:30 AM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPA observed another structure which was locked and is used as a bakery and the contents of which is mostly baking supplies and holiday decorations. Facility has an internet access device available for resident use. Facility has internet service available to residents in care and the telephone was tested an operational during inspection.

Facility's 2 fire extinguishers were observed charged and were last serviced 12/2024. Licensee agrees to