Facility Evaluation Report

Licensing Program Analysts (LPAs) Hanna Gough, Nancy Guillen and Licensing Program Manager Sheila Santos made an unannounced visit for the purpose of conducting a required annual Inspection. LPAs were greeted and granted entry by care provider Samantha Dimichina after explaining the purpose of the visit. Administrator (AD) Alan Shelley was notified via telephone and later arrived to assist with the inspection. LPAs observed the Administrator certificate was current and expires March 24, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to 6 non-ambulatory residents with a hospice waiver for 4. The facility is a one story home with six resident bedrooms, three bathrooms, and an attached three car garage.

While waiting for the AD, LPAs began review of the records. LPA Guillen reviewed four resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPAs observed staff records reviewed have a current First Aid certificate.

During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPAs observed residents watching television in the living room and resting in their respective bedrooms. LPAs observed four residents in care and four staff present. LPAs observed the See Something Say Something Poster (PUB 475) mounted on the wall by the garage exit. LPA advised AD to have PUB 475 to be relocated to the entryway of the facility, AD proceeded to place the PUB 475 poster in the entry way of the facility; a technical advisory was given on today’s date. All resident bedrooms had the required furnishings. LPAs observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPAs observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPAs observed all windows were appropriately screened.