Facility Evaluation Report

Licensing Program Analysts (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required

annual visit at 2:20 PM. This annual had a specific emphasis on infection control practices and procedures.

The LPA met with Administrator Ivy Sudjati and Allan Santos and discussed the reason for the visit. The LPA, along with Administrator, toured the physical plant areas inside and outside at 2:40 p.m. to ensure there are no health and safety hazards. Entrance interview conducted.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean

linens, appropriate furnishings and sufficient lighting. There are 5 total bedrooms – two (2) bedrooms are shared rooms, two (2) bedrooms are private rooms and one (1) room is for staff.

RESTROOMS: Three (3) restrooms for resident use were observed to be clean and sanitary and in operating condition. The bathrooms and showers were also observed to have grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. Water temperature was tested and was within normal ranges.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good

condition. At the time of the visit, common seating area and dining room furniture was observed to be in good

condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the

required postings in the common hallway. Fire extinguishers were observed to be serviced within the last

year. Smoke detectors and carbon monoxide was observed to be in operable condition at the time of visit.

The backyard has a covered area equipped with furniture for resident use. There are no bodies of water noted. Laundry room contained locked storage area for laundry supplies. Medication was observed to be locked and contained at least a 30-day supply.