Facility Evaluation Report

Licensing Program Analysts (LPAs) B. Miranda & M. Vega conducted an unannounced visit today for the facility’s annual inspection. LPAs introduced themselves and was allowed entrance into the facility. LPAs met with Sally M. Jackson.

Facility is licensed for 6 residents and has a current census of 4. There are 0 residents on hospice and 1 with a health care plan. Home Health plan is current. Water temperature was checked in the kitchen which read at 105 degrees Fahrenheit. Fire Extinguisher was purchased February 19, 2026 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order. Facility has wrought iron gate that was not in place, when facility received fire clearance. Facility has a chain link lock at the top of a door leading to the backyard and a sliding lock on the top of the side door. In a common bathroom LPA observed broken tile in front of the toilet, bath tub stained, and no non-slip mat. Liability insurance is not current, expired May 2026.

Rosanda J. Anderson Administrator's Certification expires June 26, 2026. Sally has been “Administrator” since January 2026, a written notice was not submitted to the Dept within 30-day. Staff files were reviewed, are complete, and current. Resident files were reviewed. Facility provided a log for disaster drills. Last drill was conducted in January 2026. First aid kit on site. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications. Medications were reviewed and not properly recorded. Facility does not have a centrally stored medication log for the residents.