Facility Evaluation Report

On 6/3/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by Staff, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility.

The inspection tool was used to complete today's visit.

At 10:00am LPA with the help of the Staff, began a physical plant tour of the facility and the following was observed: This is a single-story building with three (3) bedrooms, three (3) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) Ambulatory Residents, No Dementia Care, and Hospice waiver for four (4) residents. There are three (3) licensed RCFEs in the property.

Kitchen: LPA observed a seven-day supply of non-perishable food and a two-day supply of perishable food, all properly stored and labeled. Knives and other sharp items are secured in a locked box placed on the kitchen cabinet, that remains under staff supervision. An emergency supply of food and water was stored inside the pantry located in the hallway next to the laundry closet. LPA observed one fully charged fire extinguisher in the kitchen area, with a service date of 1/7/2026. A weekly menu was also posted and available for review.

Common Areas : The common areas include the living and dining rooms. LPA observed these areas to be clean, well-organized, and free of clutter. Furniture appeared relatively new and in good repair, with seating capacity appropriate for the number of residents. Walls, floors, windows, screens, and blinds were clean and in good condition.