Facility Evaluation Report

At 10:30a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met the Administrator who granted entry to the facility and explained the reason for the visit.

At approximately 10:45a.m., LPA and Administrator conducted a physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. Required postings were observed in the entry area and hallway. The dual smoke/carbon monoxide detectors are functioning properly located in each bedroom, dining area and hallways. The fire extinguisher is in the dining room and laundry area with purchased date of 05/03/2025. During the visit the facility is set at 75 degrees Fahrenheit. The facility is fire cleared for six (6) non-ambulatory residents; of which one (1) may be bedridden; six (6) hospice waiver. Fire Emergency drill was last conducted on 01/06/2026. The facility is currently occupying six (6) residents.

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

Kitchen: LPA observed kitchen appliances and fixtures were functional. The kitchen has a working gas stove, freezer, refrigerator, microwave and dish washer. LPA found at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrapped and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean