Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Maria Quiogue and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. The physical plant was inspected along with medications, food supply, and residents and staff records. The facility is licensed to serve 6 residents over 60 years old of which 4 may be non-ambulatory, with a Hospice Waiver approved for 3. The facility currently has 4 residents. Currently 2 residents on hospice.

The facility is a single story structure located in a residential neighborhood. It consists of the following: 3 resident bedrooms ( one is shared), 1 staff room, 2 bathrooms, kitchen, dining room, living room, laundry area, attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Sharps, cleaning supplies are locked and inaccessible to residents. Smoke / Carbon monoxide detectors were in compliance and operational. There are 2 fire extinguishers ( in the kitchen and in the hallway) which are fully charged. The common areas (dining room, living room) are clean and were properly furnished. Covered Fireplace observed in the living room. Resident rooms were sanitary and had the required furniture and furnishings. Oxygen tank was observed in share bedroom and "No Smoking - Oxygen in Use" sign was posted outside resident room doors. LPA observed medications are centrally stored and locked in the dining room. Laundry are was observed in the garage. Garage door was locked at the time of visit. Extra freezer was observed in the garage. There are extra clean linen and towels in garage cabinet. Continue 809C