Facility Evaluation Report

On 8/22/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver/DCS Bryan Cordero, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall next to the entrance area. The Administrator Jeffrey Savella contacted over the phone.

The inspection tool was used to complete the visit.

At 12:45pm, LPA with the help of caregiver began a physical plant tour of the facility and the following was observed: This is a single-story building with five (5) bedrooms, of which four (4) bedrooms are designated for residents’ use and one bedroom designated for staff use only. There are four (4) bathrooms, kitchen, common areas: living and dining rooms, and outdoor areas. It has an approved fire clearance for six (6) Non-ambulatory residents, of which one (1) may be Bedridden for bedroom #3. The facility also has a Hospice waiver for six (6) residents.

Common Areas : The facility maintains a comfortable temperature at 77°F. The living room and dining area appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility were observed.

Kitchen: At approximately 12:50pm LPA toured the kitchen area and observed enough supplies of non-perishable for a minimum of 1 week and perishable for 2 days at the facility. Sharps/knives were properly stored and locked inside the kitchen cabinet. There is a fire extinguisher on the kitchen wall which was last serviced on 2/13/2025. Chemicals observed to be locked inside the laundry room cabinet located in the backyard of the property, and inaccessible to residents in care. Continue on LIC809-C