Facility Evaluation Report

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the annual inspection. LPA Allen, met with Svetlana Dagala- Caregiver and she was inform of the purpose of the visit.

The facility is licensed for (4) non-ambulatory residents age 60 and over. The facility has a hospice waiver for three (3) residents. Currently, there are 3 residents, all are over the age of 60. There is 2 (two) residents receiving hospice care services. The facility does not handle any of the residents’ money.

The facility is a two-story structure located in a residential neighborhood. The first-floor licensed facility consists of the following: 3 resident bedrooms, (2) bathrooms, living room, dining room table and full kitchen. There is an adjacent enclosed patio/activity room area. There is a laundry area (located in the attached garage) and an outdoor shaded patio area.

LPA toured the Resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 105- 120.F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational.