Facility Evaluation Report

At 11:45am, Licensing Program Analysts (LPAs), Angela Panushkina and Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the Administrator and explained the reason for the visit.

Facility is licensed for capacity of six (6) Non-Ambulatory, of which one (1) may be Bedridden in room #1 only. Hospice waiver is granted for two (2) residents.

At approximately 12:00pm, LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. There is a fire extinguisher in the kitchen was fully charged.

LPAs observed five (5) bedrooms designated for residents’ use. All bedrooms have sufficient lighting, properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility also has awake staff at night.

There are two (2) full bathrooms. All bathrooms were observed to be clean and in good repair. Properly supplied with toilet paper, soap and paper towels. The hot water temperature measured at 105.8°F. LPAs observed appropriate grab bar and non-skid mat. All trash cans in bathrooms had fitted lids to protect them from cross contamination.

The facility maintains a comfortable temperature at 75°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents.