Facility Evaluation Report

On 8/27/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Administrator Estela Monderin, 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 the hallway wall next to the kitchen area.

The inspection tool was used to complete the visit.

At 9:45am LPA jointly with the Administrator began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, all rooms designated for residents’ use and one staff bedroom designated for staff use only. There are two (2) bathrooms, kitchen, common areas: living and dining rooms, and outdoor areas. Facility has an approved fire clearance for five (5) Non-ambulatory residents. The facility also has a Hospice waiver for five (5) residents.

Common Areas : The facility maintains a comfortable temperature at 78°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 10:20am LPA toured the kitchen area and observed enough supplies of non-perishable for minimum 1 week and perishable food 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 countertop, which was last serviced on 7/10/2025. Chemicals observed to be locked under the sink and inaccessible to residents in care.