Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps, met with Administrator Nelson Jabon for an unannounced one (1) year Required visit for this facility.

LPA arrived at 12:40 pm and was greeted by the Administrator. Two (2) residents were observed in the living room watching TV. The rest of the residents were observed to be in their room sleeping and/or resting. LPA informed the Administrator of the purpose of the visit.

Infection control: LPA Stamps reviewed facility mitigation plan (approved on 03/25/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was screened by the Administrator and asked all infection control questions. LPA was asked to sign-in and sanitize/wash hands.

A physical plant tour was conducted with the Administrator at 12:47 pm. The facility has five (5) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) bedroom and one (1) bathroom is designated for staff use only. The facility is Fire Cleared for five (5) non- ambulatory and one (1) bedridden.

LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each resident. LPA tested the exit doors auditory system, and it was observed to be operational for each room.

At 1:00 pm LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Hot water was tested at 1:05 pm and measured within regulation at 117.0 degrees F.