Facility Evaluation Report

On 11/18/25 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual requiredl inspection. LPA met with administrator (ADM) and staff (S1, S2) and explained the purpose of the visit. LPA observed administrator has a current ARF certificate # 6078238735 which expires 08/21/27.

At 1:15PM, LPA toured the facility including but not limited to common areas, kitchen, bedroom, and shared bathrooms. to front entrance, screening station, hand washing stations, common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs maintained at a central location and easily accessible for staff. Comfortable temperature is maintained at 76 deg F. Fire extinguisher was observed fully charged and purchased on 08/15/25. Facility has a mitigation plan in place and maintains records of routine screening for residents and staff. The infection control leader is the administrator. Hot water temperature was measured at 119 deg F. LPA reviewed 3 staff and 4 client files during visit.

Updated copies of the following documents were obtained from administrator:

· LIC308- Designation of Facility Responsibility

· LIC610E- Emergency/Disaster Plan including infection control plans

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.