Facility Evaluation Report

Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to the facility today to conduct required 1 year inspection. During today’s visit, LPA met with Licensee Janice Jabonero and explain the purpose of today's visit. LPA Frank toured the facility, inspected resident rooms and bathrooms, reviewed staff training records. LPA Frank reviewed centrally stored medications and records, reviewed food services, and inspected the kitchen. LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log, COVID posters throughout the facility.

In addition, LPA Frank tested the hot water temperature, which measured 112.3 degrees F in resident

bathroom. Resident areas were noted to be a comfortable temperature. Smoke detectors and carbon

monoxide detectors were tested and found to be operational. The facility also has fire extinguisher that was

mounted and charged. LPA Frank confirmed food supply: 2 day supply of perishables and 7 day supply of

non-perishable food is available for the number of residents present. Hygiene supplies and supply of linen

were observed in quantities for the number of residents in care. LPA observed locked areas for toxins and

hazardous items. Medication were observed locked in cabinet.

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

LPA Frank reviewed : 1.) Emergency Disaster Plan (LIC610E); 2 ) LIC 9020A Client Roster; LIC 808)

Mitigation Plan and 3) Current Liability Insurance, Designation of Administrative Responsibility (LIC308) and

Based on the observations made during today’s visit, no deficiencies are being cited in area inspected.

This report was discussed with the facility representative and a copy was provided.