Facility Evaluation Report

Licensing Program Analysts (LPA), Nadia Shabazian, conducted an unannounced annual inspection at the facility mentioned above. LPA met with Dominor Viernes-Caregiver and explained the reason for the visit. LPA spoke with Dina Alger - Administrator, over the telephone, who stated that she has a scheduled medical procedure and is unable to come. Administrator designated Dominor Viernes to sign the report. At approximately 1:20 pm, Administrator-Dina Alger entered the facility and met with LPA.

The facility is approved for six (6) non-ambulatory residents, all of whom may be bedridden. Facility's hospice approval was increased to total of six (6) residents. Current census is four (4).

At 9:40 am, LPA conducted a physical tour, with the assistance of staff and observed the following:

Required postings were observed in the living room and dining room walls. The smoke/carbon monoxide detectors are hardwired and interconnected. At 10:20 am, the smoke/carbon monoxide detectors were tested and functioned properly. There are five (5) fire extinguishers located in the kitchen, front entry, hallway, patio and in the converted garage. All the fire extinguishers were fully charged on 08/01/2024.

Kitchen: Appliances consisted of stove, dishwasher, microwave and refrigerator. LPA checks all the appliances for cleanliness and observed them to be clean and operational. All knives and sharps observed to be locked in a kitchen drawer and chemicals were locked underneath the sink, inaccessible to residents. The cabinets were supplied with plenty of non-perishable foods, for minimum of 1 week; and refrigerator was supplied with perishable foods for 2 days. There were plenty of dishes maintained in the kitchen cabinets. Thee kitchen has a door, leading to the laundry room. LPA observed laundry detergents and chemicals in locked cabinets. The laundry machines included one washer and one dryer, which were in functional mode. There is an exit door in the laundry room, which leads to the backyard.