Facility Evaluation Report

On 1/22/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Caregiver Mercy Malano, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the entrance wall and on kitchen wall. At approximately 1:45pm LPA requested staff and residents’ rosters for review.

The inspection tool was used to complete the visit.

At 2:10pm LPA, with the help of the Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms all designated for residents’ use. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, two (2) bedridden resident for room #4, and a Hospice waiver for four (4) residents.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps under the sink inside the locked cabinet. Sufficient amount of emergency supply of food / water was readily available. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located on the kitchen wall. The fire extinguisher was last serviced on 12/30/2025. Dish soap and other chemicals were observed to be stored inside the locked cabinet and inaccessible to residents in care.