Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Required 1-Year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms, and temperature was checked. LPA Bunker met JoAnn Tito, Roberto Rito, the Caregivers, and Sheryl Tongo, the Administrator. LPA Bunker explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Plan. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for (1) ambulatory and (5) non-ambulatory residents. The facility has a hospice waiver for 2 residents. There are currently four (4) residents in placement. The facility's annual fees are current.

The following 12 Domains will be observed and reviewed: Infection Control, Operational Requirement, Physical Plant & Environmental Safety, Staffing, Personnel Records-Training, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records-Incident Reports, Disaster Preparedness, Resident with Special Health Needs. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections.

The facility is a single-family home located in a residential neighborhood. Caregivers JoAnn Tito, Roberto Rito, and LPA Bunker toured the facility which consisted of the following: Living room, dining area, kitchen, sitting area, 6 residents bedrooms, 1 staff bedroom, 2 client bathrooms, 1 staff bathroom, laundry room, backyard has a shaded area with patio furniture, a table and six chairs, and a indoor/outdoor activity areas.