Facility Evaluation Report

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Mohamed Massaquoi and explained the purpose of the visit.

Upon arrival, LPA Moleski observed two staff members present (S1-S2). S1 said they had been working at this facility for one week. Massaquoi said that S1's start date was Wednesday, 2/26/25. LPA Moleski reviewed Guardian records and observed that S1 was associated to this facility as of 3/1/25, but was not cleared prior to that date. S2 said that they had been working at this facility for three years on an on-call basis. LPA Moleski reviewed Guardian records and observed that S2 was not associated to this facility.

LPA Moleski reviewed five resident files (R1-R5) and one staff file (S2). S1 did not have a personnel file. Massaquoi said he was still working on completing S1's file. Massaquoi said that S2's personnel file was located at another facility. Massaquoi left and returned with S2's file, which was missing several required elements.

R1 moved in as of 3/2/25. R1 did not have a medical assessment [LIC 602] on file prior to admission. R1's pre-placement appraisal was partially completed, and indicated that R1 is non-ambulatory, but did not include an appraisal of R1's health history, mental condition, or any social factors. The partially completed pre-placement appraisal was not signed by R1 and/or R1's responsible parties, but was signed by Massaquoi. R2's pre-placement appraisal was signed by all parties, but was signed on 2/27/25, one day after their admission date of 2/26/25. R4, who was admitted on 2/18/25, did not have any pre-placement appraisal on file. Additionally, R4's LIC 602 did not include any tuberculosis test results or the results of a chest x-ray.

LPA Moleski reviewed four residents' LIC 602s (R2-R5). As previously mentioned, R1 did not have an LIC 602 on file. R2-R5 all had LIC 602s which identified them as non-ambulatory. [continued on 809-C]