Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Chita Beltara and explained the reason for the visit. At approximately 09:40am, with the assistance of the Administrator, LPA took a tour of the physical plant and observed the following: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The fire extinguisher is located by the kitchen area and was serviced on 10/06/25. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and they were tested and observed to be operational Bedrooms: There were four (4) bedrooms in the facility. Three (3) designated for residents' use. All three (3) bedrooms are designated for shared use. One (1) room is designated for staff use. All bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 105.9 and 106.6 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. Laundry Room: The laundry room was locked and inaccessible to residents. Temperature: Facility maintains a comfortable temperature of 76 degrees Fahrenheit.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards.The gates at both sides of the home were checked to ensure no locks were installed, and that exits and passageways were clear for emergency evacuation. Garage: LPA observed that garage is used only as storage. LPA observed extra fridge and water supplies.