Facility Evaluation Report

Licensing Program Analysts (LPAs) Simi Rai & Mita Partoza conducted an unannounced Required 1 Year visit and met with Administrator Designee, Kathleen Anne Reboton. LPAs Rai & Partoza observed 3 staff and 5 residents at the facility.

During visit, LPAs Rai & Partoza toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai & Partoza toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPAs observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

The facility bathroom had available soap, paper towels, and trash cans with lids. The shower had grab bars and non-skid mats. The water temperature in the bathroom sinks ranged from 113.7F to 116.4F. The water temperature in the kitchen sink was 121.4F. Fire extinguisher was observed and inspected on Sept. 12, 2023. Facility smoke detectors and carbon monoxide detectors were in working condition. 3 out of 3 resident bedrooms had available bedding, drawers, and functioning lights.

LPA Rai & Partoza reviewed facility records for 2 staff and 3 residents. LPA Rai & Partoza reviewed resident medications and central stored medication records. During a random review/audit of resident's medication bottle and LIC 622 Centrally Stored Medication and Destruction Record. LPAs along with Administrator Designee counted the tablets from the medication bottles. LPAs reviewed R1's Centrally Stored Medication Records with the stored medications.