Facility Evaluation Report

At 9:00 AM, Licensing Program Manager, (LPM) Nichelle Gilyard, and Licensing Program Analyst, (LPA) Huma Rahimi, conducted an unannounced Plan of Correction (POC) visit.

LPM and LPA met with the staff Jaizel Mabuti. The Administrator Jose Hernandez was contacted via telephone and explained the reason for the visit. Facility designee Maria Victoria Paredes appeared to assist with the visit and to accept the report.

The purpose of the plan of correction visit to make sure deficiencies from annual visit dated May 11, 2024, and Case management visit May 22, 2024, were corrected.

1. Plan of correction met. Incident report for May 11, 2024, was emailed to LPA by the due date, however Incident report for May 19, 2024, in regard to a hospitalization was not submitted to CCL. It is now more than 7 days a new citation and civil penalty will be issued.

Annual visit- May 11, 2024- The following is not cleared:

1. 87303 ( e)(5)-LPA toured facility hall bathroom, next to room #3. No non-skid mat observed in the shower. This is posses a potential slip and fall hazard to the resident in care. Plan of correction not met.

2. 1569.625(b)(2)- LPA reviewed staff records. No training presented. Plan of correct not met.

3. 1569.625(b)(1)- LPA reviewed staff records. No training presented. Plan of correction not met.

4. 87458(a)- LPA reviewed resident records. No updated Physicians report for R2/R3. Plan of correction not met.

5. 87506(b)- LPA reviewed resident records. While the Admissions agreement was complete for R2, the appraisal for R3 was not completed. Plan of correction not met.