Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced required annual inspection. LPA identified herself, was granted entry, and discussed the purpose of the visit with Administrator Derafera. The facility is licensed for a maximum capacity of six (6) residents, all of whom may be bedridden. The facility's current census is six (6) residents, four (4) of whom are bedridden and receiving hospice care, and two (2) residents that are non-ambulatory, who were all present.

During today's visit LPA Correia, accompanied by Administrator Derafera, conducted a tour of the interior of the facility. The facility was equipped with smoke alarms, fire extinguishers, carbon monoxide detectors, and a sprinkler system that were all up to date and operational. Cleaning solutions and toxins are housed in a locked room, medication is maintained in a locked medication cart, and sharps are in a locked drawer. LPA observed all the required furnishings in resident bedrooms, and the resident bathrooms were equipped with grab bars and non-slip flooring, and nightlights in the facility hallways. The facility’s ambient temperature at the time of visit was 75 degrees Fahrenheit. LPA observed the facility to be sanitary and in good repair. There is a large common area to facilitate visitation and resident activities. There is a landline and internet available for residents’ use. Per the facility Administrator there are no firearms or ammunition on the premises. During today’s visit LPA also secured facility records.

Due to time constraints the comprehensive annual inspection began, however, will be continued later.

No deficiencies were cited during today’s visit. An exit interview was conducted with Administrator Derafera, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.