Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Vilbert Keshishi and explained the purpose of this visit.

A tour of the physical plant was conducted at 9:18 AM and the following was observed:

The facility has one main entrance being used, screening station is located immediately upon entrance and had a table equipped with hand sanitizer, gloves, mask and sign in sheet. The facility has an approved mitigation and Infection plan on file.

The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms. An additional bedroom and one (1) bathroom is designated for staff use. Fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #1. Hospice waiver for six (6) residents.

Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 74°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher located in the kitchen and observed to be last bought on 02/08/26.