Facility Evaluation Report

On November 5, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 3:42 PM to conducted an unannounced Case Management visit for a Health and Safety Check. Purpose of visit is due to a self reported incident by the facility on 10/30/2024. LPA met with caregiver, Roxanne Pedro.

During today's visit, LPA toured the facility with caregiver and observed facility to be clean and tidy and

residents to be calm and comfortable. The facility was maintained at a comfortable temperature of 72

degrees Fahrenheit. Hot water temperature was measured within the required range of 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables. No food was expired. The facility had the required grab bars and anti-skid flooring. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard.

Based on the information obtained in the self reported unusual incident report, the following is being requested of the facility:

During today’s visit Licensing requested the following documents by Friday, November 8th, 202 4 :

· SOC 341-Report of Suspected Dependent Adult/Elder Abuse

· Copies of Internal staff training that facility has stated they have conducted – this shall include the topics discussed, the training agenda, the date of training(s), which staff attended, sign in/out log to verify attendance

· Copies of all cross reports facility states they have made

· Any extra services that facility has offered to anyone who may have needed support related to incident

An exit interview was conducted. This report is reviewed and discussed with the Caregiver, Roxanne Pedro; A copy is provided.