Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA Vaid met Kristina Brown who allowed entry into facility. LVN, Margaret Grancich was notified and arrived shortly after to assist with the visit. The facility is licensed to serve six (6) non-ambulatory residents, ages 60 and above, of which one (1) may be bedridden. Bedroom#6 is approved for bedridden. The facility has an approved Hospice Waiver (for six (6) residents) and a Dementia Care program. Administrator certificate is pending, and the expiration date is 07/22/2025.

During the visit, the CARE tool was used, staff /residents were interviewed, staff/residents’ records were reviewed, physical plant was conducted, food supply was reviewed, and medications were reviewed.

The facility is a single-family residence located in a neighborhood, consisting of six (6) bedrooms, three (3) full bathrooms, 1 half bath (only has a toilet and a sink), kitchen, dining room, sunroom, den, nook, laundry room, office, and living room with a TV. No pools and bodies of water on the premises. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was measured at 108.2, 106.9, 107.9 and 114.6 degrees Fahrenheit for 4 bathrooms which were within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Auditory alarm devices to monitor exits were operable. Sufficient supply of perishable and nonperishable foods is observed. Smoke and carbon monoxide detectors are dual/hardwired and operable. Fire extinguishers’ last service is 02/03/2025 and are fully charged. Medication is centrally stored in a locked cabinet and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Continued on 809C...............