Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by the Caregiver/Designee, Maria Ana Rodriguez. LPA signed in and checked their temperature on a thermometer affixed to the wall. In the facility LPA observed two (2) caregivers and six (6) residents. The Caregiver/Designee informed the Licensee, Anne Gregorio that LPA was at the facility. The administrator, Daisy Hailey and the licensee will not be able to meet with LPA today. LPA explained the reason for the visit.

At 9:05 AM, LPA initiated a physical plant tour of the facility inside and out and the following was observed.

LPA observed appropriate postings at the entry of the facility which included a facility sketch and LIC610E. The facility has an open concept space with the living room, dining area and kitchen . The areas were clean, clear of clutter and were properly furnished. The dining area had a table and chairs that sit the capacity of the facility. Living area had a television and seating for the capacity of the facility. LPA observed two carbon monoxide detector one by the entry and another in the hallway by bedroom #3 and #4. They were tested and observed functioning properly. The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed knives locked in a kitchen drawer. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food. LPA observed one (1) fire extinguisher fully charged with a last serviced date of 05/08/2025. LPA inspected five (5) out of five (5) resident bedrooms . One (1) out of the five (5) bedrooms is a shared bedroom. LPA observed each resident room to be properly furnished with a bed, a night stand, one chair, bedding, sufficient lighting and storage. LPA opened exterior doors in all resident bedrooms and observed the auditory alarms were functional. (Continued on LIC809-C)