Facility Evaluation Report

On 12/21/23, Licensing Program Analysts (LPA) L. Salazar and LPA Doucette arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPAs were greeted by Staff, stated the purpose of the visit and was allowed entry into the facility. Administrator arrived to the facility a few minutes later. Staff provided a tour of the facility inside and out. Licensee Representative/Administrator on record is Manharlal Doolabh, Certificate #6003965735 Expires 04/2024.

LPAs observed 6 residents in care at the time of visit. Facility is a 6 bedroom / 2 bathroom home. 4 bedrooms are designated for residents in care. 2 out of 6 residents have their own bedrooms, 4 out of the 6 residents share bedrooms. Two bedrooms are designated for four(4) live-in staff. Bathroom #1 is designated for Staff and Bathroom # 2 is designated for all residents in care.

LPA's observed the following during the tour:

Bedroom #1 - Resident R1's room has broken dresser drawer knobs.

Bedroom #2 - Resident R2's room has a thin mattress with no box spring, door and door frame are observed to be dirty and need to be repainted or deep cleaned.

Bedroom #3 - Resident R3's room has a dresser with broken knobs.

Bedroom #4 - Resident's R4's room had a dresser facing the wall, making the drawers inaccessible.

No resident room was observed to have personal lighting. Facility temperature was 64 degrees F. Facility turned heater on upon LPA's arrival.

Bathroom #1 was observed to have rust along outside base of the bathtub. The door and door frame are observed to be dirty and need to be repainted or deep cleaned. Bathroom #2 was observed to have a wet and slippery tile floor. No protective device or non-skid mat was observed in the all tiled bathroom. Ceiling was observed to be wet with condensation, toilet paper holder is broken and toilet paper was observed to be on the back of the toilet. Bathroom tile was broken on the base of the floor in the shower, bathroom light fixture is rusted, wall light switch plate has mildew. Flooring is broken around the toilet causing a tripping hazard. No covered trash can was observed. Exhaust fan did not adequately clear the condensation in the bathroom. Hot water temperature tested at 111.3 degrees F. (Continued on LIC 809-C)