Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert conducted an unannounced case management visit regarding an Incident Report received in our office on May 19, 2025. LPA was greeted and granted entry by House Manager, Teotima Apostol and LPA explained the purpose of the visit. Administrator, Maxine Kniazeff was in a meeting and was unable to meet at the facility.

The purpose of the visit is to follow-up on a Death Report received in our office. LPA spoke to Licensee (LE) Augustine Au via phone and requested Resident #1 (R1)'s: Identification Form, Physician's Report, Needs and Services Plan/ Appraisal, Pre-appraisal, Progress Notes as well as copies of the Staffing schedule for May 2025. LE will email documents to LPA by end-of-business on May 21, 2025.

LPA interviewed House Manager who was present during the incident and spoke about the chronological order of events. LPA observed the five residents in the facility engaged with one another, on tablets and waiting for dinner.

An exit interview was conducted with Teotima Apostol and a copy of this report was provided at exit.