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25 | On June 11, 2024 at 1:20pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Shimon Cagen and explained the purpose of the visit.
The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, attached garage, and an outside covered patio area.
LPA Kim toured indoor and outdoor of the physical plant with AD Cagen. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 113.1 and 114.1 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility.
LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food and water are stored in the garage. Emergency supplies are stored in medication closet. The facility has two (2) fire extinguishers that are charged and they were all serviced on March 12, 2024 and smoke/carbon monoxide detectors were operable.
Evaluation Report Continues on LIC 809-C
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