Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required Annual Inspection and met with staff, Maria Butuza. Administrator, John Butuza, arrived at 11:00 am. LPA observed (1) resident watching television in their room before leaving to attend a medical appointment. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (1) resident. Currently, there is (1) resident. and the resident is not on hospice

LPA and caregiver toured the interior/exterior of the facility including common areas, (6) private resident bedrooms, (3) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring, and hygiene supplies. Medications are locked in a designated closet, and toxins are locked in the laundry area. The inside temperature measured 74*F and the hot water measured 120*F in the kitchen. The fire extinguisher was last serviced Feb 11, 2025. One smoke/monoxide alarm was tested/sounded. There are door alarms on the exit doors. The driveway area is open and can be used for emergency exit. All required postings were observed. There is a patio table outside as well as a vegetable garden.

LPA reviewed (1) resident and (2) staff files. Files were organized and contain current documentation, including care plan. Administrator has current RCFE #7004713740 (exp 6/14/26) and both staff have current First Aid/CPR certifications. Staff completed required annual training in August 2024. Administrator to obtain updated Dementia care information for Plan of Ops and create an addendum for the Admission Agreement to reflect regulation changes, fire arms policy and provide complete contact information for Ombudsman and the Department. All facility contact information is current. There were no deficiencies observed.