Facility Evaluation Report

On 2/11/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Andretta Smith. LPA was granted entry. Administrator (A1) Cecelia Bravo greeted LPA shortly after LPA’s entrance to the facility. No residents were present as they are attending day program.

LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 38 degrees F. Fire extinguisher was observed with a purchase date of: 9/17/24. Fire drill last completed on 1/24/25. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature of 114.6 degrees F in bathroom 1, 118.0 degrees F. in bathroom 2 and 114.6 degrees F in bathroom 3. Non-skid mat and grab bars observed in bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. Samples of medications were checked and observed kept locked in the cabinet. Residents’ MARS was reviewed. First aide kit observed with all of the required items.

All residents files and samples of staff files reviewed to have all the required documents.

No deficiencies issued during this inspection.