Facility Evaluation Report

At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. Upon arrival, LPA met with Manager/Caregiver whom granted entry to the facility and explained the reason for the visit. Later Licensee joined today’s visit.

At approximately 10:15a.m., LPA and Manager/Caregiver conducted a physical plant tour inside and out. During the tour, LPA observed that the facility is a one-story home located in a residential community. The home has four (4) bedrooms, two (2) full bathrooms, one (1) 1/2 bathroom; living room / dining area, and kitchen. There is a small office located next to front door. Required postings were observed in the entry area. The smoke alarms are operational, located in each bedroom and hallways. Front yard landscape is in good condition at time of this visit. There is a carbon monoxide detector that functions properly. The fire extinguisher is in the kitchen with purchased date of 12/10/2024. During the visit the facility is at 74 degrees Fahrenheit. The facility is licensed to serve 6 (six) non- ambulatory residents ages 60 and over of which 1 (one) may be bedridden and facility is approved to retain six (6) residents on hospice. The facility cares for elderly residents with dementia. Fire Emergency drill was last conducted on 11/10/2025. The facility is currently occupying five (05) residents.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Kitchen: LPA observed kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found at least two (02) days perishable and seven (07)