Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:15am to conducted a 1 year annual visit to the facility above. LPA met with back up to Administrator Robert Budai and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Facility staff need to be trained upon hire and annually thereafter on infection control and plan.

Physical Plant & Environment Safety: The facility is a 5 bedroom with 2 on suite bathrooms and 1 main restroom for residents, staff and visitors. The facility currently occupies 4 residents, and is staffed with 4 staff and 2 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gates are self-closing and self-latching. The facility has outdoor furniture for residents use with shaded area. Laundry room has working washer and dryer. Water was tested in the main restroom measured at 152.2 F, Administrator turned down water heater and LPA at end of visit tested and measured at 143.6, Administrator adjusted the water heater and will check temperature again and adjust if needed.

Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current liability insurance valid till 06/15/2026. The fire clearance is granted for 6 non-ambulatory, of which 1 may be bedridden. Hospice wavier granted for 4. Continued 809-C