Facility Evaluation Report

On 06/04/26 Licensing Program Analyst (LPA) Villegas conducted an unannounced Annual required visit using the new Care Inspection Tool. LPA was met by the Administrator Rosemarie Famison as the purpose of today’s visit was explained. The facility is licensed to serve 6 adults ages 60 and older of which (3) may be non-ambulatory and (1) bedridden. There is an approved hospice waiver for (6). Facility fees are current. Administrator certificate is active (7028457740 Exp: 08/11/26). Liability insurance is active (PCI42577191-04 EXP05/25/27).

The facility is a single-story structure located in a residential neighborhood and consists of the following: a living, dining room, kitchen, (4) bedrooms, (1) staff bedroom, (2) bathrooms, an outdoor laundry/ storage area, a ramp that is accessed from bedroom #1, a detached garage, a backyard with shaded sitting. There is a working land line. There are no bodies of water or firearms on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for residents personal belongings was observed. Walls and floors were in good repair. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries available. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knives are stored and inaccessible to residents. There no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards. Fire extinguishers were charged, smoke detectors and carbon Monoxide are operable. Last fire drill was conducted on 04/20/26. LPA observed a first aid kit and manual.

LPA reviewed 3 staff files and 5 resident records, and 5 medication administration records (MAR).

Exit interview conducted, appeal rights explained, and a copy of the report was provided to