Facility Evaluation Report

On 6/3/2026 at 3:00 PM, Licensing Program Analyst (LPA) A. Gomez conducted a Health & Safety inspection as a result of the department receiving notice that the licensee passed away. LPA met with Backup Administrator, Ana Breen and explained the purpose of the visit.

LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. The hot water temperature in the residents’ bathrooms were measured between 105-120 degrees Fahrenheit. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Facility grocery shops on a weekly basis. Resident's medications were kept locked in cabinet. Smoke detectors and carbon monoxide detector observe. First-aid kit was complete. Fire extinguisher was last serviced on 10/14/2025. Indoor and outdoor passageways are free of obstruction. Sharps and toxic are locked and inaccessible to residents in care.

Facility currently has Four (4) residents. There were two (2) caregivers on duty at the time of the inspection. LPA spoke with Backup Administrator, Ana Breen who is next of kin, who states that they would like to begin the Emergency Approval to Operate (EAO) procedures and has submitted documents to the department. Backup Administrator states that they will submit additional required documents as soon as possible/available and will file an application for a new license.

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