Facility Evaluation Report

On 7/28/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Administrator Illenberger Jeffrey Michael, who granted access to the facility. LPA introduced herself by showing her department badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit.

At 1:15pm LPA began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, two (2) bathrooms, kitchen, garage, common areas, and outdoor areas. This facility is a Residential Care Facility for the Elderly (RCFE). A fire clearance was approved for six (6) Non-Ambulatory residents and one (1) Bedridden resident. The facility also has a Hospice waiver for two (2) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected; they were tested and are operational. The facility has three (3) fire extinguishers that were last purchased on 9/28/24: the first one is located by the entrance, on the wall, the second one is located in the kitchen area, and third one is on the hallway by bedroom #4.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. An emergency supply of food / water was stored inside the kitchen cabinets and pantry. Food storage and preparation areas are clean and inaccessible to pests. A weekly menu was also available for clients.