Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to conduct the required annual inspection, LPA was greeted by Staff April Magat, identified herself, and was granted entry into the facility. The facility is licensed to serve six (6) residents; of which all can be non-ambulatory, three (3) can be receiving Hospice Services, and one (1) resident may be bedridden. The current census is four (4) residents in care.

LPA Correia conducted a resident records review and a partial facility tour. Per today's facility visit resident records were complete and up to date. During the facility tour LPA observed smoke and carbon monoxide detectors were present and operable, fire extinguishers were present and current on inspection, and the facility has a landline.

An overall inspection of the facility began today, however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection.

No deficiencies were cited during today's visit. This report was discussed with Staff Magat, and a copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.