Facility Evaluation Report

Licensing Program Analyst (LPA) K. Kontilis conducted an unannounced Annual Inspection and Infection Control Inspection of the facility. A mitigation plan has been submitted to CCLD. LPA arrived at the facility at approximately 11:30 AM and was greeted by Staff 1 (S1). Administrator Tharanganie Mohottigue arrived at approximately 11:51 AM. LPA inspected the one-story facility for fire safety, personal accommodations, and food service.

There are currently five (5) residents residing in the facility. There are no residents currently on hospice. There are two (2) ambulatory residents and three (3) non-ambulatory residents.

At the time of arrival, there were three staff available in the facility and five (5) residents present in the facility.

LPA toured the facility with Administrator. LPA observed five (5) resident bedrooms, and one (1) staff bedroom. Bedrooms #1, 2, and 4 are private rooms with private bathrooms. Bedrooms 3 and 5 are private bedrooms with a shared bathroom off the hallway.

Walls, floors, and doorways are clean with no safety hazards. The kitchen area consists of a counter top area, a refrigerator, a stove, a microwave, and a sink. Sharps and centrally stored medications are kept in a locked cabinet in the dining area with no access to residents. First aid kit was observed to be complete. Fire inspection was current.

There is a sufficient amount of perishables for seven (7) days and non-perishables for two (2) days. Emergency food is stored in a second refrigerator and pantry located in the garage. There is a washing machine and a clothes dryer in the garage. Chemicals and toxic substances are kept in a locked cabinet under the kitchen sink.

There is one carbon monoxide alarm and eight smoke alarms.