Facility Evaluation Report

Licensing Program Analyst (LPA) Natasha Persaud conducted a Case Management - Deficiencies visit. LPA was greeted and allowed entry into the facility by Staff, Petra Galindez. LPA spoke with Administrator, Raushon Ahmed via telephone, while at the facility.

Today, LPA was at the facility regarding a complaint investigation and observed deficiencies. LPA observed a black box in the fridge storing a former resident's medication. The box was not locked and medications were made accessible to residents in care. The fridge/freezer located inside the facility did not have a sufficient food supply. The freezer contained frozen food items, such as Banquet dinners and pot pies. The freezer was not sanitary and had debris and particles. The fridge had 1 package of hot dogs and some tupperware that contained food, but it was unlabeled/unidentified. The pantry contained a bag of hot dog buns, a case of Top Ramen noodles and one case of canned vegetables. The fridge located in the garage contained an egg carton with 5 eggs, and one loaf of bread. The freezer had one zip lock bag with raw chicken, which was not labeled or dated. The freezer had dried blood all along the base of the inside of the freezer.

In addition, LPA requested resident records for Resident #1 (R1) and Resident #2 (R2) and was made aware by the administrator that the files were incomplete. The administrator stated the resident's were admitted to the facility without the required documentation due to the administrator being ill, and they were behind on their paperwork. LPA explained the importance on required documentation for admittance. Resident #3's Resident Appraisal was not current with a date of 08/2024. Also, R1 left the facility on 12/30/25 to go to the store and didn't return. The administrator did not complete an incident report and assumed the report was not needed, as R1 was not returning to the facility.

Deficiencies were observed and cited on the attached LIC 809D. A civil penalty is being assessed for a repeat violation within a 12 month period. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Petra Galindez whose signature below confirms receipt of these rights.