Facility Evaluation Report

On 12/07/2022 at 9:30 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual/Infection Control inspection. LPA was greeted by Staff #1 (S1) who was wearing a mask and granted access. S1 took LPA temperature S1 called the Administrator Merlina Ebreo to inform them LPA was here. Merlina met us shortly after. LPA explained the reason for the visit. LPA reviewed the Mitigation Plan approved 02/07/2021. The inspection tool was used to complete the visit.

At 9:37 a.m. LPA began a physical plant tour of the facility and the following was observed:

Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed 2-day perishable and 7-day non-perishable supply of food. The fire extinguisher was observed by the kitchen and was last serviced on 11/25/2022.

Dining / Living Area: The dining and living area were well lit, clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is not in use. LPA observed proper Covid-19 signs posted through out the facility. LPA observed the thermostat at a comfortable temperature of 75°F.

Bedrooms: There are four (4) bedrooms designated for resident use. One (1) out of the four (4) rooms is currently vacant. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens.

Bathrooms : There are two (2) bathrooms designated for resident use. One (1) bathroom is located in a resident's bedroom for private use. The other main bathroom is accessible to all the residents. Both bathrooms were well lit, clean, had grab bars, had hand washing signs, nonskid mats and trash bins with lids. LPA observed a sufficient supply of hand soup and paper towels. At approximately 10:00 a.m. water temperature in the main bathroom was measured at 119.3°F.