Facility Evaluation Report

On 09/15/25 Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility for an unannounced one (1) year Required visit and was greeted by a caregiver. Caregiver called administrator and LPA was informed that the Administrator, Monica Gory, would not be able to meet with LPA. LPA informed the Administrator of the purpose of the visit via phone and the Administrator designated caregiver Julissa Dubon Hall to sign the report. Three (3) out of the five (5) residents were observed to be in their room sleeping, watching TV and/or resting. Two (2) residents were attending day program.

A tour of the physical plant was conducted with the designee at 12:00 pm. The facility has five (5) bedrooms and two (2) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for four (4) ambulatory, two (2) non-ambulatory residents, and a hospice waiver for one (1). Currently the facility has no residents on hospice.

Administrative: Annual fee is current. LIC 500, Client roster and Liability insurance will be emailed to LPA.

Infection control: LPA previously reviewed the facility mitigation plan (approved on 03/ 1 8/21) to make sure the licensee was following current infection control recommendations.

Resident Rooms: LP A observed rooms to have the appropriate bedding, nightstand, a chair and sufficient lighting for each resident . LPA observed the staff room to have a locked filing cabinet for staff and resident files. Currently the staff office has an extra freezer, and extra supplies.