Facility Evaluation Report

At 10:15 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an unannounced annual inspection visit to the above facility and met with an individual who was cleaning the facility. LPA contacted the Administrator via telephone and explained the reason for the visit. The facility currently do not have any residents. The Administrator stated that she has an intent of surrendering the license and expecting to sell the property soon. The Administrator continued to state that she will notify Community Care Licensing Division (CCLD) once she makes her final decision about the closure of the facility. LPA informed the Administrator that the license is not transferable. The Administrator arrived at 11:00 AM, LPA and the Administrator toured the facility and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of five (5). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 07/28/2025 and was observed hanging on the wall in the kitchen.

MEDICATION ROOM: The centrally stored medication cabinet is in the living room. LPA did not observe any medication in the cabinet.

BEDROOMS: There are three (3) bedrooms designated for resident’s use. Bedrooms number one (1) and two (2) are shared. Bedroom (3) is used for a bedridden resident. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Continue on LIC 809C