Facility Evaluation Report

Licensing Program Analyst (LPA) Shobhana Frank arrived to conducted an announced visit to the facility for purpose of a Pre-licensing/Comp III Visit. LPA was greeted at the door by Licensure Alim Rea Badillo granted entry and lead the tour of the facility indoors and outdoors.

An initial application to operate Residential Care Facility for the Elderly, age 60 years and over, for (6) capacity, (6) non-ambulatory resident was submitted to CCL on 04/28/2021. LPA observed 3 non - ambulatory residents at the time of Pre licensing inspection, from three residents 1 residents is receiving hospice care. The facility has 3 staff and 3 residents and all are vaccines Pfizer vaccine on February 18, 2021 from CVS pharmacy.

structure: Facility is a single story 4 bedrooms and 2 bathrooms house with an attached garage.

LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, visitors log. LPA observed COVID posters throughout the facility.

LPA observe the facility to be clean and in good repair.

Bedrooms Residents: two bedrooms are single occupancy and two bedrooms are shared bedrooms. All bathrooms have a working toilet, wash basin, grab bar, rolling shower, accommodates non-ambulatory clients in a wheel chair.

Adequate supply of linens and hygiene supplies are stored in main hallway closet.

Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review in the kitchen

Food Service: Adequate supply of 7- day non-perishable and 2- day perishables are stored in the kitchen. Kitchen was observed to be clean and in order. Sharps were observed to be kept in a locked closet.