Facility Evaluation Report

On 11/23/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Ivy Jane Bertulfo and explained the purpose of today’s visit. The facility is licensed to operate for five (5) non-ambulatory of which one (1) may be bedridden elderly adults ages 60 and above.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (3) common bathrooms, a living area, a dining area, a kitchen, and an outside patio area.

LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 107.5 degree F. A comfortable temperature of 71 degree was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A landline telephone was in working condition. A review of staff CPR/First Aid training is current.