Facility Evaluation Report

Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff Andrea Graham and LPA explained the purpose of the visit. Licensee granted permission to do a walk through of the facility with caregiver staff. Licensee Tynetta Shabazz arrived at the facility at about

The residence was set at 69 degrees F temperature and free of passageway obstructions inside and outside. LPA observed three bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean and orderly with resident's pictures and decor. Water was tested and measured at 111.4 degrees F.

Infection Control, Disaster Emergency Plan, and Plan of Operation was reviewed.

Food is stored properly for perishable and nonperishable. Medication and knives are locked and stored next to the kitchen. Cleaning supplies are locked in the garage. Incontinence supplies are stored in the closet next to the kitchen. Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was last serviced on 04/09/2025. Last Fire Drill was on 03/02/2026.

Three Resident files and staff files were reviewed.

An exit interview was conducted, and a copy of this report was provided to Licensee, Tynetta Shabazz whose signature confirms receipt.