Facility Evaluation Report

On 7/28/2023, at 11:30 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver Barinder Kaur who was informed of the purpose of visit. Administrator Hemalata Bansode arrived during the visit. The facility is approved for three (3) ambulatory and three (3) non-ambulatory residents, of which one may be bedridden. Facility has a hospice waiver for three (3) residents. During the visit, there was four (4) residents and (1) staff present. LPA toured the facility’s interior and exterior with Caregiver Kaur, and observed the following:

Kitchen: LPA observed kitchen to be clean. Food is stored in a safe and healthful manner. LPA observed the facility had sufficient perishable and non-perishable food items. Knives/sharps are secured in a locked kitchen cabinet.

Dining and Living room: LPA observed area to be clean and furniture in good condition. LPA observed a resident resting in the living room and the other residents sleeping in their rooms.

Hallway : LPA observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detectors were tested and functioning properly. Fire extinguisher is charged and mounted on entrance hallway.

Bedrooms : Resident bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting. During tour of Resident #1's bedroom, LPA observed R1's mattress was soiled/stained. Deficiency cited.