Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Jennifer Leon, Administrator and explained the purpose of the visit. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, of (1) may be bedridden designated to room #4. Hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs. Bathroom has hygiene items such as paper towel, hand soap and toilet paper.

Operational Requirements: Plan of operation and training logs were reviewed. Th e facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place a nd expires 0 6/01/2026.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (7) bedrooms, (5) of which are resident bedrooms, (1) staff bedroom, (1) administrator/licensee room, (2) bathrooms, living room with covered fireplace, dining room, kitchen, attached garage, laundry area and backyard with patio area. There are currently (6) residents, (2) are under hospice care and (1) bedridden. The interior and exterior physical plant was inspected. Resident bedrooms were toured and each bedroom has the required furniture. Backyard was inspected and has a shaded area for outdoor activities. LPA observed a gardener working in the backyard installing water sprinklers during the visit. There are (2) fire extinguishers in the facility last serviced on 02/04/2025, however licensee, purchased a new fire extinguisher during the visit. Smoke detectors and carbon monoxide were tested and operable. There are no pools/ large bodies of water , firearms or weapons stored in the facility. The hot water temperature was measured between the required range of 105-120 degrees F. *****REPORT CONTINUED ON LIC809-C*****