Facility Evaluation Report

At approximately 8:55 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) Nathaniel Neish. Caregiver Rosllin Sadullah arrived at 2:00 PM. The Facility currently has no Administrator. This deficiency will be cited. Forever Sarahs Anna Home is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for four (4) residents. One (1) resident can be non-ambulatory. Upon arrival, LPA was informed that there were three (3) residents in care. Two (2) residents were away at day programs during the inspection. At approximately 9:15 AM, LPA reviewed the Facility's Staff Roster and found that two (2) staff members (S2 & S3) were not background cleared on Guardian. This deficiency will be cited. A civil penalty is being issue for this deficiency. All remaining staff were background cleared and associated to the facility per regulation.

At approximately 9:25 AM, LPA toured the facility with CG Neish . All exits were clear and unobstructed. Two (2) fire extinguishers were last serviced and tagged in 3/2024. One (1) of three (3) fire extinguishers was last serviced and tagged in 9/2013. This deficiency will be cited. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is not conducting quarterly fire and emergency drills per regulation. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements.