Facility Evaluation Report

On 9/16/2025 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator, Editha Santos. LPA explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, family room and kitchen area. No residents currently at the facility. At 2pm, residents started arriving from Day Program. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 118 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Resident bathrooms were observed to be in good repair equipped with grab bars and non-skid floor. Sharps and toxic materials were observed locked and inaccessible to residents. Food supply in was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide monitor is working and fire extinguisher were present throughout the facility. Emergency drills are done quarterly.

Six resident records and two staff records were reviewed. Resident’s PNI money was counted and all accounted for. Staff have criminal record and fingerprint clearances on file. Resident records were reviewed and were observed to be complete.Centrally stored medication was locked in the medicine cart and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated.

No deficiencies are cited at this time. Report is reviewed and copy is provided.