Facility Evaluation Report

On 06/12/2026 at 11:15AM, Licensing Program Analyst (LPA) Andrew Christy arrived unannounced to conduct the 1-Year Annual Required inspection. LPA met with Administrator, Aurora Cicai, and explained the purpose of the visit. The facility currently houses three (3) residents with a max capacity of six (6) residents.

LPA 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 70.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 105.1 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 06/04/2026.

At 12:30PM, LPA reviewed three (3) resident files and three (3) staff files, all found to be complete. The emergency disaster plan was last reviewed 05/15/2026. Quarterly emergency drills were last conducted 05/11/2026. 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.