Facility Evaluation Report

On 11/05/2025 at 8:30AM, Licensing Program Analysts (LPAs) Andrew Christy and James Sampair arrived unannounced to conduct a Required Annual Inspection. Upon entry into the facility, the LPAs informed administrator Victor Rodriguez of the purpose of the visit. The facility currently houses four (4) residents out of a maximum capacity of six (6) residents

The LPAs toured the facility inside and outside. The LPAs inspected the kitchen, common areas, bedrooms, bathrooms, and the exterior of the facility. The facility was clean, appropriately furnished, and well lit. More than the 2 days of perishable and 7 days of nonperishable food supplies were available. No body of water was on the facility grounds. Bathrooms and showers were observed to be fully functioning and clean. The hot water temperature in the bathroom was 114.3 degrees Fahrenheit. The room temperature of the living room was 70.0 degrees Fahrenheit. Carbon monoxide and smoke detectors were operational. The fire extinguisher was last serviced on 12/10/2024. The LPAs observed required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. Toxins and sharp objects were in locked storage and made inaccessible to residents.

The LPAs reviewed 4 resident records and 5 staff records, and all were found to be complete. The Emergency Disaster Plan was last reviewed 10/09/2025. Quarterly emergency drills were last conducted 10/01/2025. Centrally stored medications and the Medication Administration Record (MAR) were reviewed and no outstanding errors were found.

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