Facility Evaluation Report

On 1/6/2023 at around 10:20 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Robert Smith. LPA explained the purpose of the visit and was accompanied by Licensee inside and outside the facility during this inspection.

This facility is licensed to serve 6 non-ambulatory adults ages 60 and above, of which 1 may bedridden. This facility is approved for 4 hospice residents.

A total of 4 residents are currently residing in this facility, of which 1 is a non-ambulatory resident.

The facility is a one-story house located in a residential street. The home consists of 3 resident bedrooms, 2 bathrooms, 1 living room, 1 dining/office room, 1 kitchen, 1 attached garage, and 1 backyard patio area with shaded seating.

Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet.