Facility Evaluation Report

On 1/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Staff Member (SM) Nehomi Macfarlane and explained the purpose of the visit. LPA as SM Macfarlane to call the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. Shortly after, LPA met with Licensee Marinela Placintar and explained the purpose of the visit.

There were two other staff members present at the time of this visit, Marsha Spencer and Christopher Nnam.

This facility is licensed to serve 6 non-ambulatory elderly residents at this time. This facility has a hospice waiver allowable for 2 residents at this time.

The current census was 5. A brief interview with Licensee Placintar was conducted.

LPA Pascua reviewed 4 resident files and 3 staff files. 4 out 4 residents files were current and up to date. There are currently 2 residents were receiving hospice services. LPA Pascua reviewed 3 staff files. 3 out 3 staff files were complete and up to date. The administrator does not have an active administrator certificate #6036635740 and expired on 08/30/2023, however is awaiting for the department for a renewed certificate. LPA was able to confirm that the administrator provided the department documentation and payment prior to the expiration date.

A fire extinguisher was also observed to be in the kitchen and was annually inspected by Jorgenson Co on 03/18/2022

The kitchen area was toured. LPA observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.