Facility Evaluation Report

On February 12, 2025 Licensing Program Analyst (LPA) Deborah Lee arrived at facility to conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Jose Umana as the purpose of todays visit was explained. The facility is licensed to operate for 6 ambulatory residents of which 6 can be non-ambulatory, ages 60 and over and is approved hospice waiver for 6 residents. There are 2 residents currently on hospice. Current facility census is 6. Licensing fee status discussed with Administrator at time of visit.

Structure: The facility is a single-story structure located in a residential neighborhood and consists of the following: 6 bedrooms, 2 common restrooms, 1 private restroom, laundry room, dining area, kitchen, pantry, linen closet, 1 staff office area and a designated outdoor shaded area. The facility has a working landline telephone.

Physical Plant LPA and Administrator Jose Umana toured the facility inside and outside. LPA observed There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: Facility license, personal rights, ombudsman information poster, facility sketch, exit signs, infectious disease postings, Administrator certificates, an emergency disaster plan .