Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Administrator Designee, Lucian Mititti, stating the reason for today's inspection. LPA observed (1) resident in the common area and (3) residents resting in their rooms. Also present were caregivers, Tiffany Dominguez and Larisa Vornices. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Currently there are (0) residents on hospice. The upstairs area is not used by residents.

LPA and Administrator Designee toured the interior/exterior of the facility including the common areas, (6) resident bedrooms (w/half bath each), (2) full bathrooms, kitchen, office, large activity room, staff rooms (2) and laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, slip-resistant flooring, and paper towels. LPA observed sufficient 2+day perishable, including fresh produce and dairy, and 7+day non-perishable supply of food. Sharps and toxins are secured in the kitchen, and resident medications are locked in the office area. The inside temperature measured 75*F and the hot water measured 115*F in a resident bathroom (matched the hot water temperature sensor in the hallway). There are sufficient linens, towels, blankets and PPE supplies. The smoke/monoxide alarms are working and the fire extinguisher was last serviced 3/14/25. All required posting are visible, and there are non-audio cameras in the hallway. Administrator RCFE certificate #7035813740 is valid through 10/13/26. Administrator Designee also has a current certificate. Annual fees are current. Admission Agreement reflects all regulation changes made in Jan 2025 and Plan of Ops to be updated.

LPA reviewed (2) resident files/medications and (3) staff files. Files were organized and medications are administered per orders. PRN is documented. All staff are cleared/associated and staff is completing required training, including First Aid/CPR. Updated insurance information obtained. There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided.