Facility Evaluation Report

On 09/26/2025 at 8:30AM, Licensing Program Analysts (LPAs) James Sampair and Andrew Christy arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs met with Administrator Tina Camaclang and explained the purpose of the visit. The facility currently houses five (5) residents.

The LPAs inspected the interior and exterior of the facility. The inspection of the physical plant included the kitchen, dining area, restrooms, community living spaces, resident rooms, storage areas, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. The hot water temperature in the bathroom was measured to 105.1 degrees Fahrenheit. The room temperature of the living room was 71.2 degrees Fahrenheit. Fire Extinguisher was last maintained 06/05/2025. The carbon monoxide and smoke detectors were fully operational.

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. Five (5) resident files and five (5) files were reviewed. The Emergency Disaster Plan was last updated 09/06/2025. The Quarterly Emergency Drill was last conducted 07/06/2025.

The following deficiency was found during the visit:

An incident report for 09/17/2025 was not properly filed and sent to the overseeing LPA.

Further information on this citation can be found on form LIC809D. Exit interview conducted and a copy of this report, along with appeal rights, was provided.