Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct an Annual Inspection. LPA was granted entry by Staff Yolanda Bravo. Staff Yolanda Bravo contacted Supervisor Rosemary Bravo who responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply was observed to not have a 7 day non perishable supply of non perishable but had a 2 day supply of perishable. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 137.8 F degrees F. Facility was set at 75 F.

Fire extinguisher serviced on 06/27/2025. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility has a pull station fire alarm. Last fire drill conducted 8/18/2025. All cleaning supplies are locked and secured in a cabinet in the garage.

LPA's reviewed resident and staff files which were complete. On 09/18/25 facility staff did not log medications were administered for C2. After conducting a medication count, the medication was administered.

Exterior tour conducted. Side gate was observed to be self-latching.

An exit interview was conducted with the Supervisor Rosemary Bravo and a copy of this report with plans of correction and appeal rights were provided.