Facility Evaluation Report

At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after, and LPA explained the reason for the visit.

Facility is licensed for capacity of six (6) residents of which five (5) are non-ambulatory and (1) bedridden, in room #1. LPA observed that currently there are five (5) residents in care, two (2) of which are under hospice care.

At approximately 10:00am, LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. There is a fire extinguisher in the kitchen, and it was last serviced on 08/11/2026.

At approximately 10:20am, LPA observed medications are centrally stored and locked in six (6) drawer double cabinet, located by the kitchen area and inaccessible to residents in care. LPA also observed a First Aid Kit complete with the required items as per Title 22 Regulations.

There are four (4) bedrooms designated for residents’ use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. LPA observed that R5 (in room #4) had a hospital bed with ½ bed rail . LPA reviewed R5's facility file and did not observe a written doctor’s order.