Routine inspection·May 3, 2024

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection visit. LPA met with administrator Vivian Fragiacomo and explained purpose of today's inspection. Prior to entry LPA was tested for COVID via rapid testing. LPA was screened appropriately prior to entry. PPE supply is observed as in place stored through out the facility via substations. There is also PPE stored in storage closets in main dining room area. Staff is observed wearing masks through out the facility. Mitigation and infection control plans are current and being followed. This is a single level facility. Hospice waiver for 12 residents of which there are 7 residents under hospice care. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients. Facility ambient temperature is warm and comfortable at 71F per facility thermostat, and lighting is sufficient for residents and staff safety. Toilet and bathing facilities are equipped with grab bars and non-skid mats. LPA observed one shower room adjacent to room 20. Shower rooms have pull cords present. Water temperature is tested in shower room at 120F. Liquid soap and paper towels are present in resident room bathrooms observed. LPA observed resident rooms 8 and 5 which have pull cords in place. Resident rooms observed contain all required furnishings and lighting. Facility has three first-aid kits that are in place through out the facility. A Disaster and Mass Casualty Plan is observed as posited. Additional food supplies are observed as in place in main kitchen and storage area. Two day perishable and one week non-perishable food supplies are observed as in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact are current. Fire extinguishers inspected are current with inspection tags dated 04/01/2024. Carbon monoxide detectors are observed as in place through out the facility. Facility is fully equipped with fire sprinklers. Continued on next page... Page 2 - LIC809 Janitor closet is observed in the dining room area as locked and contains cleaning supplies and pre measuring equipment for use by cleaning staff. Laundry room is also observed adjacent to the kitchen area behind key pad locked door as functioning and clean. Facility is equipped with full fire sprinkler system. Fire alarm system, including the fire control panel, was last inspected on 03/06/2024 per records reviewed. Emergency disaster drills are conducted quarterly last taken place in January 2024 at 2pm. Emergency egress routes were followed and observed to be free and clear of obstructions. Per file reviews made records observed as current. Administrator certificate is current and expiring November 2024. Facility does not handle resident monies. The following updated forms are being requested to be received by 05/10/2024 : • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Control of Property No citations issued. Report is reviewed the administrator Vivian Fragiacomo.