Facility Evaluation Report

On 09/05/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Robert Smith, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) residents aged 60 and up, five (5) of which may be non-ambulatory and one (1) bedridden, with an approved hospice waiver for four (4) residents.

Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. The facility consists of three (3) resident bedrooms, 2 bathrooms, living room, dining room, office area, kitchen, and attached garage. In the back is a patio with table and chairs available for resident use. LPA did not observe any bodies of water on the premises. There are no security bars on the windows.

Bedrooms LPA inspected the three (3) resident bedrooms and observed them to be clean and in good repair. LPA observed resident rooms have the required furniture, including beds, dresser, nightstand, chair, and storage space for resident’s personal belongings. LPA observed the resident beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in good repair.

Bathroom LPA inspected the bathrooms and observed them to meet Title 22 regulations. LPA observed the bathrooms are clean and operational. LPA observed there are secured safety handrails in the showers. LPA observed an ample supply of towels and hand towels. LPA observed an ample supply of hygiene supplies. The water temperature measured 110.5-degrees and 111.8-degrees Fahrenheit. LPA observed cleaning supplies secured in a locked cabinet

Kitchen LPA observed the kitchen was clean and sanitary. LPA observed an ample supply of dishware, cookware, and cutlery. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. LPA observed knives and sharps secured in a locked cabinet. The water temperature measured 110.6-degrees Fahrenheit.