Facility Evaluation Report

Licensing Program Analysts (LPA's), Yelena Avetisyan and Evelin Rios, conducted an unannounced Required 1 Year inspection. Upon arrival LPA's met with the staff who contacted the administrator via telephone. Administrator Raymond M. Viray arrived approximately 10::45 am.

At approximately 10:35 am LPA's observed staff 2 (S2) walk outside the facility towards the exit door located in the office area and unlock the exit door from the outside.

Approximately 10:40 am LPA's conducted physical plan inspection and observed the following.

BEDROOMS: The five resident bedrooms had appropriate furnishings, clean linens and sufficient lighting. While touring the rooms at approximately 10:42 am LPA's observed half rail placed on bed in room # 1, room # 2, Room # 3 and room #5. LPA's also observed full rail being utilized in room # 5. LPA's also observed exit doorknob in room #5 with a cover to prevent the door from opening. LPA's also observed The LPA's conducted review of resident and hospice files and did not observe physicians orders for the half rails. Review of hospice care plan for resident #5 did not indicate the need for the full rails. Approximately 10:42 am while conducting physical plant tour LPA's briefly spoke with Staff 1 (S1) who informed the LPA's that they reposition Resident 1 (R1)Resident 2 (R2), Resident 3(R3). RESTROOMS: Restrooms (2) were clean and sanitary with grab bars and non-skid surfaces. The LPA observed hand washing signs in all restrooms. At approximately 10:52 am while touring the office area LPA's observed a second fire extinguisher that was inspected/serviced on 1/11/2019

KITCHEN: Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable but did not have sufficient 7 day supply of non-perishable food. At 10:58 am while touring the kitchen LPA's observed the fire extinguisher was serviced on 1/11/2019.