Facility Evaluation Report

On 01/24/2025 at 10:25AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver Gilbert, Villota spoke with Administrator, Shahid Siddiqui via telephone, and explained the purpose of the visit. The Administrator currently holds a certificate (#6043867740) that expires on 03/15/2025. The facility’s fire clearance was approved for eight (8) non-ambulatory residents. Administrator had to leave during visit and gave authorization to Gilbert Villota, Caregiver to sign reports.

LPA toured the facility with Caregiver, Gilbert Villota including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms and four (4) bathrooms. one (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 119.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 11/14/2024. Emergency Disaster Plan was last posted on 02/05/2024. First aid kit was observed to be complete. Fire drill was last conducted on 09/14/2019.