Facility Evaluation Report

On 04/05/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Caregiver, Cristina StoDomingo, and the purpose of today’s visit was explained. The facility is licensed for 6 non-ambulatory residents over the age of 60, with a hospice waiver for 6 residents. Currently six (6) residents reside at the facility, and all six (6) were present during the visit.

Physical Plant/Structure The facility is a single-story home in a residential neighborhood. The facility consists of six (6) resident bedrooms, five (5) bathrooms, living room, dining room, kitchen, and garage. LPA toured the inside and outside of the facility. The front yard was observed to be landscaped and well maintained. The backyard has a covered patio with a large table and chairs to accommodate all residents. An additional table and chair are under the shade of a tree. The backyard is landscaped and well maintained. LPA observed all walkways around the home to be clean, clear, and free of debris, obstructions, and hazards. LPA did not observe any bodies of water on the premises.