Facility Evaluation Report

Licensing Program Analysts (LPA) Alberto Lopez and Sanjay Vaid conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Staff Jermin Hendriette and Gloria M De Jesus and explained the purpose of the visit.

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. entrance. sufficient PPE supplies and has an Infection Control Plan posted by the entrance.

Physical Plant & Environment Safety: The 1-story facility is not in good repair. Fire and carbon monoxide detectors are in every room and were operation. One can of Raid was accessible to residents and staff locked it up right away. Fire extinguisher is located at facility and serviced.

Operational Requirements: The facility has plan to accept or retain clients with dementia. The facility does not have proof of enough liability insurance covering injury to residents and guest.

The 1-story facility consist of the following: 5 Resident Bedrooms and 3 Resident Bathrooms, dining room, living room, TV room, and backyard area.

Staffing : There appears to be sufficient staffing at the facility. The administrator’s INDRAWATI, YENNY certificate expired 12/17/2021. Staff employed are all over the age of 18.

Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid training but no evidence of on-going training.