Facility Evaluation Report

On 09/26/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff. Administrator Matthew Palmer and Area Manager Irene Formentera arrived later. Facility is licensed to serve six (6) non-ambulatory of which two (2) may be bedridden. The facility also has an approved hospice waiver for six (6) residents. There are currently two (2) residents receiving hospice care services. The annual fees are current.

The home consists of one (1) floor level which includes: one (1) staff room, four (4) resident rooms, two (2) bathrooms, kitchen, laundry area, dining room, living room, backyard patio area with furniture, and a detached garage. The facility is clean, sanitary, and in good repair.

Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Common bathrooms were checked. Continue to LIC809-C.