Facility Evaluation Report

On 01/15/2025 at 2:07 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct an unannounced Required Annual inspection. LPA was greeted by Staff #1 (S1). LPA signed in and checked temperature by entry. S1 called the administrator. Lily Anne Gagarin the administrator designee met LPA shortly after. LPA explained the reason for the visit. This is a Residential Care Facility for the Elderly (RCFE) with an approved fire clearance for 6 bedridden residents with a hospice waiver for 4. The inspection tool was used to complete the visit.

At 2:12 p.m. LPA began a physical plant tour of the facility inside and out and the following was observed:

Kitchen: LPA observed required postings on a wall leading to the office. LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. LPA observed an adequate amount of tableware for the capacity of the facility. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed a 2-day perishable and 7-day non perishable food supply; properly stored and labeled. The fire extinguisher was observed by the kitchen, fully charged with a receipt of purchase from 03/04/2024.

Dining / Living Area: The dining and living area were clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area was not in use and secured with a glass screen. LPA observed the thermostat at a comfortable temperature of 71°F.

Bedrooms: A fire extinguisher was observed in the hallway leading to the bedrooms and was fully charged. There are four (4) bedrooms designated for resident use. One (1) out of the four (4) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. LPA observed a built in closet with extra linens. Auditory alarms on exit doors were functioning properly.