Facility Evaluation Report

01/21/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently two residents in care. Facility approved/cleared for four non-ambulatory and hospice waiver for two.

LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food.

All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 106.3 degrees F, within the range of 105 to 120 degrees F. Fire extinguishers were last inspected February 2025. Toxins are located in the hallway closet. Sharps are stored in a cabinet located in the kitchen. Medications were found to be centrally stored. LPA conducted spot medication count and found prescription medication to be missing expiration/start dates (Technical Violation).

LPA conducted a review of two resident records. LPA observed resident R1 and R2 to not have needs and service plan and pre admission appraisal (Deficiency Cited). R2 did not have a personal rights form (Technical Violation). LPA conducted review of two staff records/training. Upon a review of staff records, LPA found staff (S1) to not have a health screening/tb test on file. Per conversation with administrator, they have the documents but were unable to find them during the inspection. LPA was unable to review S2's personnel file as the facility was unable to locate the file during the inspection (Deficiency Cited).