Facility Evaluation Report

On 07/23/26 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and spoke to administrator on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with ADM and S1. ADM has current administrator certificate# 7000732740 which expired 04/19/27.

At 1:15PM, LPA inspected including, but not limited to, living room, bathrooms, bedrooms, kitchen, dining area, garage and outside areas. Facility has four (4) bedrooms and three (3) bathrooms. One bedroom and one bathroom designated for staff use only. 2 day perishable and 7 day non-perishable food supply available. Sufficient lighting and furnishing observed. Ample linens and toiletries available. Medications, toxins and sharps stored locked. There were no bodies of water present during inspection. Facility maintained a temperature of 74 degrees, F. Hot water temperature in a resident's bathroom measured at 119 degrees, F. Carbon monoxide detector, fire extinguisher and smoke detectors observed operational and fully charged. LPA reviewed 2 staff and 5 resident files. Licensee does not handle resident's cash resources.

Updated copies of the following documents were obtained during visit:

 LIC308- Designation of Facility Responsibility