Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Jaime Montero and explained the reason for the visit. At approximately 12:10 pm, with the assistance of the Administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area.

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. Bedrooms: There were six (6) bedrooms designated for residents' use. All six(6) bedrooms are designated for private use. Bedrooms in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. LPA also observed the staff area to be clean. LPA tested the fire alarms and carbon monoxide, and they were functional. The fire extinguisher is located in the kitchen. The charge date is October 15, 2025. Bathrooms: There were three (3) bathrooms in the facility. One (1) bathroom in the hallway, which is the main and one (1) bathroom in the private bedroom, and one (1) designated for staff use. Hot water temperature was measured from the bathroom sink at 105.8 and 108.7 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. There is a fireplace that is properly screened. The fireplace is non-functional. No key to the fireplace, and fireplace tools were not present. The auditory alarms on all exit doors were on and functional at the time of the visit. The dining room table is large enough to seat the capacity of the facility. Seating, such as couches, where in good repair and sits within the capacity of the facility. Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. No body of water was observed. The gate at the side of the facility was checked to ensure no locks were installed, and that exits and passageways are clear for emergency evacuation. (Continue on 809C)