Facility Evaluation Report

On 07/02/26 Licensing Program Analyst (LPA) Villegas conducted an unannounced annual inspection visit to the above facility. LPA met with Administrator Tracy Moore as the purpose of this visit was discussed. Facility is licensed to serve (6) non- ambulatory residents age 60 and over, there is an approved hospice waiver for (3). Facility fees are current. Liability insurance is active (PCI79378045-03 exp: 06/18/27), and Administrator certificate is active (7002620740 exp: 02/25/28).

This home is a single story home that consisting of the following: (3) resident bedrooms, (2) staff bedrooms, (2) resident restrooms, (1) staff restroom, an office, living room, kitchen, dining area, laundry room and an outdoor shaded patio area was observed. Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of (4) staff records, (4) resident records, and (4) medication administration records, no discrepancies observed. The facility does not handle any of the residents’ money. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 06/06/26, 1 fire extinguishers fully charged, carbon monoxide and smoke detectors are interconnected and operational.

Exit interview conducted, and a copy of this report was provided.