Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with Jocelyn Rambuyan for a Required One (1) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 12:15pm and the following was noted:

There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. The facility has enough PPE supplies.

The facility has a total of five (05) bedrooms and two (02) bathrooms for both residents and staff. The facility is fire cleared for six (06) non-ambulatory, six (06) bedridden and a hospice waiver for three (03). The facility is currently occupying five (05) residents of which two (02) are under hospice care.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water.

The living and dining rooms are neat and clean with appropriate furniture. The facility maintains a comfortable temperature at 77°F.

Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents.

The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher observed to be full and last inspected on 11/17/2022.