Inspection Report Summary
Most inspections found no deficiencies, with the most recent report on December 9, 2024, showing the facility was clean, well-maintained, and fully compliant. Earlier reports included a few isolated issues, such as missing tuberculosis exam results and a notification for a resident with hearing impairment in March 2024, and substantiated complaints about infection control lapses in October 2022 and hazardous materials accessible to residents in October 2021. These issues were addressed without fines or enforcement actions listed in the available reports. Several complaint investigations were substantiated, but none involved severe harm or license actions. The facility’s record shows improvement over time, culminating in a clean most recent inspection.
Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 1
Capacity: 6
Deficiencies: 0
Dec 9, 2024
Visit Reason
An unannounced Required Annual Inspection was conducted to evaluate compliance with licensing requirements for the facility.
Findings
The facility was found to be clean, well-maintained, and in compliance with regulations. No deficiencies were observed during the visit.
Report Facts
Licensed capacity: 6
Current census: 1
Hospice waiver: 2
Hot water temperature: 116
Fire extinguisher service date: Jun 8, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sunday Olowosagba | Administrator | Facility administrator who granted access and participated in inspection |
| Evelin Rios | Licensing Program Analyst | Conducted the inspection |
| Eva Miller | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 2
Mar 4, 2024
Visit Reason
An unannounced Required Annual Inspection was conducted to assess compliance with licensing regulations for the facility.
Findings
The facility was generally clean, well-maintained, and compliant with safety requirements; however, deficiencies were noted in resident medical records, specifically missing tuberculosis examination results and a missing Telecommunication Device Notification for one resident.
Deficiencies (2)
| Description |
|---|
| One out of three residents did not have results of a communicable tuberculosis exam on file, posing a potential health, safety, or personal rights risk. |
| Resident with hearing impairment did not have the Telecommunication Device Notification on file. |
Report Facts
Facility capacity: 6
Resident census: 3
Hot water temperature: 117.1
Plan of Correction due date: Mar 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sunday Olowosagba | Administrator | Met with Licensing Program Analyst during inspection and involved in addressing deficiencies |
| Evelin Rios | Licensing Program Analyst | Conducted the inspection and authored the report |
| Eva Miller | Licensing Program Manager | Supervisor of the inspection process |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Dec 7, 2022
Visit Reason
An unannounced annual inspection was conducted at the facility to evaluate compliance with licensing requirements.
Findings
The facility was observed to be clean, well-maintained, and in good repair with no deficiencies noted. Safety equipment such as fire extinguishers and smoke alarms were present and functional, and infection control measures were in place.
Report Facts
Water temperature: 105
Non-perishable food stock: 7
Perishable food stock: 2
Bedrooms: 3
Shared bedrooms: 2
Fire extinguisher service date: Mar 21, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sunday Olowosaga | Administrator | Facility administrator met the Licensing Program Analyst during the inspection |
| Evelin Rios | Licensing Program Analyst | Conducted the inspection and authored the report |
| Eva Miller | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Oct 5, 2022
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2022-10-04 regarding facility staff not wearing masks.
Findings
The investigation substantiated that a facility staff member was not wearing a mask during a visit on 2022-09-28, posing a potential health and safety risk. The administrator admitted the issue and agreed to provide staff training on infection control and COVID protocols.
Complaint Details
The complaint was substantiated based on observation and interviews. The allegation was that a facility staff member was not wearing a mask, which was confirmed by the administrator and observed during the investigation.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure staff complied with infection control requirements by not wearing masks, posing a potential health and safety and personal rights risk to persons in care. | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: Oct 8, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melissa Ruiz | Licensing Program Analyst | Conducted the complaint investigation |
| Sunday Olowosagba | Administrator | Facility administrator who admitted the mask-wearing issue |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 1
Oct 14, 2021
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that the licensee did not ensure that hazardous materials were inaccessible to residents.
Findings
The investigation substantiated that cleaning chemicals were accessible to residents, posing an immediate health and safety risk. However, the allegation that medications were accessible was unsubstantiated as medications were found locked and inaccessible.
Complaint Details
The complaint was substantiated regarding hazardous materials being accessible to residents. The allegation about medications being accessible was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients were found accessible to residents. | Type A |
Report Facts
Facility capacity: 6
Plan of Correction due date: Oct 16, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melissa Ruiz | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Nichelle Gillyard | Licensing Program Manager | Named in the report as Licensing Program Manager |
| Sunday Olowosagba | Administrator | Facility Administrator interviewed during investigation |
| Adesuyi Aruwajoye | Staff member who greeted LPAs and signed the report | |
| Joscelyn Martinez | Licensing Program Analyst | Assisted in conducting the complaint investigation |
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