Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Adina Sbingu, Administrator. Also present were staff Tess Mebratu and Tamara Grant. LPA observed (1) resident watching television and (4) residents in their rooms. (1) resident returned at the end of the inspection. The facility is licensed for (6) residents- (1) may be bedridden, and (5) may be non-ambulatory. There is a hospice waiver for (3)- currently no residents are on hospice.

LPA and Administrator toured the interior and exterior of the facility including the 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 without any odors. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels, and a 20-second hand-washing poster at each sink. There is sufficient 2+ day perishable and 7+day non-perishable supply of food and sharps are locked in the kitchen. Toxins are locked in the laundry room and medications are secured in a separate cabinet near the office area. Hot water measured 117*F in the kitchen and the inside temperature measured 72*F. Fire extinguishers were last serviced on 8/1/24 and the smoke/monoxide alarms are in working order. There is a complete First Aid kit, PPE/paper supplies, and sufficient linens/towels/blankets. There are flashlights and night lights plugged in. There are multiple required postings posted near the front entrance, including the Emergency Disaster Plan and Theft & Loss Policy. There are games/activities and an operating land line. All exit doors have alarms. There is a shaded outside area with a table/chairs, two exit gates in the backyard, and an outdoor kitchen and garden. LPA reviewed (2) staff and (2) resident files. Files were organized and contained current records. Medication orders and documentation was reviewed for (1) resident. Medications are administered per orders. Dementia Care plan to be updated along with the Admission Agreement. LPA requested updated copy of insurance policy, LIC500 and LIC308 by 6/17/25. There were no deficiencies observed. Exit interview. Copy of report to be emailed due to technical issues.