Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee not able to come to facility. LPA spoke to licensee via telephone, he gave caregiver permission to sign report. Facility currently has four (4) residents in care. Administrator Certificate for Ferdinand Alfonso is #7000212735 expires 6/2/27. LPA and caregiver discussed Emergency Disaster Plan, no updates were implemented.

At approximately 1:45pm LPA and caregiver toured the building and grounds. The facility was at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found open and uncovered in the freezer, caregiver immediately stored open uncovered item in a ziplock bag. Most items in the refrigerator were stored in a safe manner. LPA noticed food located in staff room, per caregiver, only they eat the food in the staff room. LPA discussed with caregiver that snacks need to be readily available for residents, such that they can help themselves to food if they wish. No snacks were present in the facility. Cleaning products and laundry soaps are located in the staff room in a locked cabinet and inaccessible to residents in care.

All bedrooms were equipped with lighting, night stand, and chest of drawers. Resident bathrooms had required bath mats and grab bars. Bathroom in back of facility has a leaking shower and leaking sink . Windows in rooms for residents (R2, R3, and R4) have black substance covering sills and black and gray substance is also present on the window screens and along the entire frame of the windows. Room for R4 is missing a window screen ( deficiency cited, see 809 D ). Water temperature in sinks measured at 113.6 degrees F in the kitchen which is within the allowable range of 105 to 120 degrees F. LPA observed couch in