Facility Evaluation Report

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. Upon arriving at the facility, LPA met with Administrator / Jennifer Leon who assisted with the visit. LPA explained the purpose of this visit. The facility is licensed to serve for a capacity of six (6) Residents ages 60 and over. The facility has an approved fire clearance for five non-ambulatory residents and one bedridden resident, designated to room #4. Hospice care waiver approved for six (6) residents. Currently, there are six (6) residents in placement. There is one (1) bedridden resident and four (4) residents receiving hospice services. The facility has an approved Dementia Care plan as part of its plan of operation and accepts/cares for residents with dementia.

The following (CARE) tool domains were observed and reviewed during today's visit: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Food Service and Health Related Services.

Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility is encouraging hand washing and self symptom check of staff and visitors. Each client bedroom is designated as a COVID-19 isolation room if needed and will use the closest restroom.

The facility is a single story home located in a residential area which consist of 2 living rooms, a kitchen, dining room, 5 resident bedrooms, 2 staff bedrooms, 2 bathrooms, a sun room/office, an attached garage/laundry area/storage and a backyard. No large bodies of water were observed.