Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted an annual inspection visit. LPAs met with Shaunda Williams (Administrator) and discussed the purpose of today’s visit.

This is a 2- story home which consist of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. All resident bedrooms are located downstairs. This facility is approved for (6) non-ambulatory residents (3 of which may be under hospice).

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Policy in place.

Operational Requirements: Facility is adhering to the operational requirements.

Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector observed and tested. The fire extinguisher observed and appeared to be full (located near the kitchen area). Last drill was conducted on 05/01/25. Bedrooms have the required furniture. Supply of food (perishable and non-perishable) observed. Bathrooms have non-skid surfaces and grab bars. Hot water temperature (hallway bathroom) measured at 130.4*. Deficiency cited.

Refer to LIC 809C for the continuation of this report.