Facility Evaluation Report

An unannounced Plan of Correction (POC) in conjunction with a Subsequent Complaint (Complaint Control # 31-AS-20210604142033 ) visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan the purpose of this visit is to follow up on the Plan of Corrections (POCs) that were issued on 6/7/2021

On 6/9/2021, 11/27/2021, 12/9/2021 LPA Avetisyan sent an email to virgil.lopez@yahoo.com notifying the administrator that plan of corrections are still outstanding. A discussion was made via email however as of today's visit the licensee/administrator have failed to submit plan of corrections to the Department.

Upon arrival to the facility LPA met with staff Consuelo Connie Cipriano and Manuel Cipriano. Ms. Cipriano contacted the licensee Waldi Lopez. Ms. Lopez informed the staff that administrator Virgilio Lopez is currently unavailable. Neither licensee or administrator were available to come to the facility. Per Staff the licensee has asked her to sign for the report.

Approximately 2:30 pm LPA conducted a tour of the facility with Ms. Cipriano. While conducting tour LPA observed the following.

RM 1: Currently being occupied by 2 residents. Resident 1 (R1) is currently utilizing a full rail and Resident # 2 (R2) is utilizing a half rail At 2:32 pm when asked staff stated that neither resident are currently receiving hospice services. Staff also informed the LPA that they have to reposition both residents every 2 hours because they are unable to do so.

RM # 2 is currently being used as a staff room.

RM # 3 is currently occupied by 1 resident (R4)

RM#4 is currently being occupied by 1 hospice resident (R3) who is utilizing a full rail.