Facility Evaluation Report

On 10/27/2025 at 8:24am, Licensing Program Analysts (LPAs) Zina Brown and Lizeth Villegas conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Jared Mikos (Director of Operations) and the purpose of the visit was discussed. Facility is licensed to serve 73 non-ambulatory residents, 7 bedridden residents and an approved hospice waiver for 7 residents. The facility does handle residents cash resources. Currently the facility has 50 residents who reside at the facility.

The facility has residents diagnosed with the following:

The facility is a 3 story building which consist of the following:

1st floor : Lobby, business offices, conference room, salon, laundry, designated smoking area outside, and parking lot

2nd floor: 20 resident rooms, outdoor shaded area, kitchen, and dining room and an emergency evacuation chair is located on the 2nd floor stairwell.

3rd floor : 20 resident rooms, activity room, library, medication and storage room.

The facility has a current administrator Jared Mikos certificate # 7008348740 (valid 08/27/2024 - 08/26/2026) The facility annual fees are current. Liability Insurance Policy is with Continuing Care Risk Retention Group, Inc (NAIC #11798) (Policy # PL0002277) is current and valid from 01/01/2025 - 01/01/2026 and as followed occurrence at $1,000,000 and general aggregate at $3,000,000. The facility has a surety bond of $6,000,000 as of April 29, 2014