Facility Evaluation Report

On 04/03/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Irene Formentera, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The facility is licensed to serve 6 non-ambulatory residents aged 60 and over, with an approved hospice waiver for four (4).

Physical Plant/Structure The facility is a two-story structure located in a residential neighborhood. The first floor consists of four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, two (2) car garage, and outside has a shaded area. The second floor consists of five (5) bedrooms, three (3) bathrooms, and a den. On the shaded back patio, LPA observed a table and chairs available for resident use. All walkways outside the facility were observed clean, clear, and free of debris, hazards, and obstructions. LPA did not observe any bodies of water on the premises.

Bedrooms LPA inspected all residents’ rooms and observed them clean and in good repair. LPA observed resident rooms have the required furniture including a bed(s), dresser(s), nightstand(s), chair(s), and storage space for resident’s personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheet, flat sheet, blanket, comforter, and pillows. LPA observed an ample supply of linens. All bedrooms were observed with ample lighting.

Bathrooms LPA inspected the bathrooms and found them to be within Title 22 Regulations. All bathrooms were observed clean and operational. All showers have a non-skid mats, shower chair, and secure safety handrails. LPA observed an ample supply of towels and hygiene products available for residents. The water temperature measured 111.3-degrees and 117.6-degrees Fahrenheit. LPA observed an ample supply of incontinent care supplies stored in resident rooms and an additional supply stored in the garage.