Facility Evaluation Report

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Staff Samantha Mercado and explained the reason for the visit.

The purpose of the visit is to complete the required inspection.

LPA Trueman toured the facility along with Staff Samantha Mercado today 04/23/2026 at 9:40 AM and the following was observed:

Facility contains 3 Resident Bedrooms and 1 Resident Bathroom, dining room, living room, and TV room.

Annual Inspection includes the following Domains:

Infection Control, Physical Plant and Environment Safety, Operational Requirements, Staffing, Personnel Records- Staff Training, Resident Records- Incident Reports, Resident Rights/ Information, Planned Activities, Food Service, Health Related Services, Incidental Medical, Disaster Preparedness, and Residents with Special Health needs.

Resident and Staff files were reviewed. All staff were cleared and associated.

Medication was administered per physician's directions.

Signage for hand washing and proper sanitizing were posted. Staff have been trained in hand washing.

Licensee maintained an individual admission agreement for each client.

Facility had sufficient supply of 2 day perishable and 7 day non-perishables meeting regulations.

Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.

There is an adequate number of direct care staff to support each resident's physical, social, emotional safety and health care needs as identified in his/her current appraisal.

Exit interview conducted and copy provided.