Facility Evaluation Report

On February 23, 2026 Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Shemeles Kabteneh.

Facility is licensed for 6 residents and has a current census of 5. There are 2 residents on hospice, and care plans are current. R1 and R2 are on hospice with doctor orders for full bed rails. Water temperature was checked in the kitchen which read at 118 degrees Fahrenheit. Fire Extinguisher was serviced 03/21/2025 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order.

Shemeles Kabteneh Administrator's Certification expired 12/7/2025, and is pending renewal. Staff files were reviewed, LPA observed training to not be current. Resident files were reviewed. Facility was able to provide a log for disaster drills that are conducted quarterly. First aid kit on site and complete. LPA observed toxins and cleaning supplies accessible in the garage. LPA observed cleaning supplies and rubbing alcohol accessible in R1's bathroom. There is a locked storage for medications.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. The garage of the facility is listed as an emergency exit, LPA observed a car and furniture partially blocking a path to exit the garage door.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights to Shemeles Kabteneh.