Facility Evaluation Report

On 09/09/2025 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual required visit. LPA was greeted by Staff #1 (S1) who granted access. S1 contacted the administrator, Monica Gory to let them know LPA was at the facility. LPA informed the administrator by telephone the purpose of the visit. Administrator met LPA shortly after.

LPA reviewed the register of facility residents, and the staff schedule. LPA initiated a physical plant tour at approximately 10:20AM, and the following was observed:

Bedrooms: There are four (4) total bedrooms for resident use. Two (2) out of the four (4) bedrooms are designated to be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient lighting. LPA observed hallway cabinets used as storage for facility supplies such as linens. LPA observed a closet by room #4 that was locked. In the closet LPA observed emergency water, a first aid kit and residents' medication.

Bathrooms: There are three (3) bathrooms. One (1) bathroom is located in a shared bedroom for private use. Bathrooms were properly supplied with toilet paper, paper towels, hand soap, and nonskid matts. LPA observed proper fixtures such as grab bars. Hot water temperature was measured at 10:54AM in the bathroom closest to the bedrooms and it read 105 degrees Fahrenheit, within regulation.

Common Areas: These include the living room and dining room. The areas were clean and clear of clutter. Passageways were free from obstructions. LPA did not observe any tripping hazards. The dining table and chairs sits the capacity of the facility. (Continue to LIC809-C)