Facility Evaluation Report

On December 14, 2023, Licensing Program Analysts(LPA) John Calandra and Licensing Program Manager(LPM) Jackie Jin arrived at the facility to conduct an unannounced to conduct the annual 1-year required inspection.

LPA and LPM toured the physical plant. The facility is one building with two floors. The Facility has 5 bedrooms and 2 bathrooms(4 resident bedrooms and 1 staff bedroom). No accessible bodies of water or hazards were observed. Water temperature in both the first and second floor bathrooms was measured at 107.9 degrees well within the required 105-120 required range. LPA Calandra and LPM Jin observed 7 days of non-perishables and 2 days of perishables. No food in the refrigerator has expired. All fire extinguishers were last serviced on January 19, 2023 and are fully charged.

All sharp objects, soap, and detergents were observed to be locked and in-accessible to persons in care.

LPA and LPM reviewed Medications Record and all resident medications which matched the instructions on the bubble pack of medication, the times of day medication should be taken were clearly noted as well as whether medications had been given to the resident.

LPA Calandra and LPM Jin interviewed 3 residents and 1 staff member.

This Annual will be completed at a later date.

No deficiencies were cited during today's visit. A copy of the report was reviewed with the Administrator and left at the facility.