Facility Evaluation Report

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified herslef to, and discussed the purpose of the visit to Maryl Evangelista, Administrator. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages sixty (60) and over. The facility is also approved for one (1) bedridden resident that may reside in bedroom #2. Hospice waiver granted for six (6). During today’s inspection there were five (5) residents in care.

LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives and sharps were locked and inaccessible to residents.