Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Caregiver Cheryl Lacambra and explained reason for visit. Administrator Nicole Axalan arrived shortly.

Facility is licensed to serve age range 60 and over. Approved for six (6) non-ambulatory residents, one (1) of which may be bedridden. Bedridden resident approved in bedroom in bedroom #3. Waiver granted for hospice care for two (2). Facility has an approved Dementia Care Plan. The facility is a single-story home located in a residential area. kitchen, dining area, living room, laundry room, 4 resident rooms, 1 caregiver room, 1 resident bathroom, 1 staff bathroom, detached garage, front yard, and backyard. There is sufficient indoor and outdoor activity space for residents.

LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. Extra linen was observed in hallway storage cabinet. The Smoke detectors and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has two (2) fully charged fire extinguishers which is kept in kitchen and laundry area. Cleaning supplies and toxic substances were observed to be inaccessible in a locked cabinet in laundry area Knives were locked under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The resident bathrooms have the required grabs bars and non-skid mats. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents outside with a garden. Passageways and exits are free of obstruction.