Facility Evaluation Report

Licensing Program Analysts (LPAs) Cynthia Chan and Jewel Baptiste conducted the unannounced annual inspection. LPA met with the house manager, Cynthia Tadeo, and explained the purpose of the visit. The facility is licensed for 9 non-ambulatory residents, ages 60 and over. There is a hospice waiver approved for (5) residents. There are currently (7) residents residing at the facility.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility has 6 bedrooms with private bathrooms, one guest restroom, living room, dining room, common area, kitchen, staff office, laundry, and a detached garage. No swimming pool or bodies of water on the premises. No items obstructing the walkways. Smoke and carbon monoxide detectors are interconnected and a fire alarm system connected to the fire department. Facility has sprinklers throughout the home. Knives and cleaning solutions are locked and inaccessible to the residents. The hot water temperature is measured within the required range of 105-120 degrees F.

LPA reviewed (3) personnel files. Administrator certificate expires on 5/1/27. Staff are fingerprint cleared and associated to the facility. Staff have current CPR & First Aid certificates. LPA reviewed seven (7) resident files and their medications. Files have the medical assessment, TB test results, and Needs/Services Plan. LPA issued technical violations for medical assessments and reappraisal. Medications are being administered as prescribed. The current Emergency Disaster Plan is posted and fire drills are conducted.

No deficiency issued today. An exit interview was held and a copy of this report, along with appeal rights, was given to C. Tadeo.