Facility Evaluation Report

On 01/07/2026 at 12:00PM, Licensing Program Analysts (LPAs) Andrew Christy and David Doidge arrived unannounced to conduct the 1-Year Annual Required inspection. LPAs met with caregiver, Antoinette Russell, and explained the purpose of the visit. Administrator Samuel Tet arrived around . The facility currently houses five (5) residents with a max capacity of six (6) residents.

LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 71.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 113.5 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/17/2025.

At 1:15PM, LPAs reviewed five (5) resident files and four (4) staff files, all found to be complete. The emergency disaster plan was last reviewed 09/01/2025. Quarterly emergency drills were last conducted 09/01/2025. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors.

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