Facility Evaluation Report

On 09/15/2025 at 11:35 am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Charesa Reyes, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents an approved hospice waiver for 1 resident. Three (3) of the residents are diagnosed with dementia, three (3) hospice resident.

The facility has a current administrator certificate (#7029005740) for Charesa Reyes (Administrator) valid from 11/21/2024 - 11/20/2026. The facility fees are current (payment made on 09/15/2025). LPA provided pin #198081 with the option for the facility to make an payment online. The facility has liability insurance with Primary Care Insurance, A Risk Retention Group, Inc (NAIC#16959) with an effective date as of (08/02/2025 - 08/26/2025) with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #PCI43093369-01)

The facility does not handle any of the residents’ money. The home is a two story home consisting of: (3) shared resident bedrooms, (2) shared bathroom, with a upstairs living quarters for the staff (with a bathroom and bedroom, a living room, kitchen with dining area, laundry room, an outdoor shaded patio area and a detached garage with an additional refrigerator.

Between the hours of 11:41am - 12:55pm , LPA conducted a records review of (6) residents records, (3) staff records and (6) Client Medication Administration Records and the facility disaster plan. All client & staff records were complete. The facility disaster plan was current (last conducted on 09/01/2025) and in compliance with Title 22 at the time of visit. LPA did not observed any discrepancies at the time of visi t.