Facility Evaluation Report

On 03/17/2025 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Josephine Mesina was informed of the visit and arrived during the visit. LPA Brown informed Licensee/Administrator Mesina of the purpose of the visit. At the time of the visit there were two (2) staffs present, and four (4) residents present.

The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of five (5) non-ambulatory residents. The facility’s approved for four (4) hospice waiver. The current census is four (4) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to the following:

Physical Plant : LPA Brown observed Resident #1 (R1) and Resident #3 (R3) were reported bedridden by their physician and the facility does not have an approved fire clearance for bedridden residents. Deficiency will be issued today, 03/17/2025 and an immediate civil penalty of $500.00 will be assessed and will continue to be assessed until corrected. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the resident bathroom to be at 106.5 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Charged fire extinguisher was also observed at the facility. Posters such as personal rights, Ombudsman poster, and the disaster plan, House Rules and Theft and Loss Policy were posted in a common area. However, LPA Brown observed the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) was not posted at the facility. Technical Violation will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. ***Continuation in LIC809C ***