Facility Evaluation Report

On 10/09/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual continuation inspection and met with House Manager Angelito Costa. The facility is licensed to serve six (6) non-ambulatory residents, in which six (6) may be bedridden. The facility has a hospice waiver approved for one terminally ill resident. The facility is a one-story house located in a residential neighborhood and consists of four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, living room, family room, shaded patio and an attached garage. The facility is clean, sanitary, and in good repair. Annual fees are current.

The House Manager 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. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place, and water temperature measured at 114.5 degrees Fahrenheit. Continue to LIC809-C.