Facility Evaluation Report

At approximately 9:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and met with Staff Members Julie De Jesus and Frank Oboza. Licensee/Administrator, Rose Marie B. Devera was contacted and arrived during visit at approximately 10:15AM. Facility is a Licensed Residential Care Facility for the Elderly (RCFE) and serves residents with dementia. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 5 residents in care and 3 staff members on-site.

At approximately 9:50 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with staff members and Licensee/Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature. Carbon monoxide and smoke detectors were tested and found to be operational. Exits were observed as free from obstruction with the exception of one emergency exit in a shared resident room where a walker and commode were placed in front of the exit. LPA advised licensee per regulation, these exits are to be maintained free from obstruction. Licensee removed the items immediately. Facility's auditory signal was observed inactivated at facility entrance and inoperable in resident room on the sliding glass door emergency exit. Licensee had staff correct this during visit. Facility had emergency lighting.

Facility is a 1 story building with 5 resident bedrooms, 1 staff bedroom, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of perishable foods as required by Title 22 Regulations, but both canned and dried non-perishable food items were observed by LPA to be expired. Licensee threw them away immediately and ordered more non-perishable foods during inspection. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. LPA observed hand towels in the common resident restroom and advised Licensee that only paper products are in compliance with regulation. Licensee removed the towels immediately. Toxins were observed to be stored inaccessible to residents except for a a can of Lysol observed in a drawer in the common resident bathroom and a bottle of isopropyl alcohol observed accessible on a shelf in the common living area. Licensee removed both items immediately.