Facility Evaluation Report

Licensing Program Analyst (LPA) Sam Haddadin conducted an unannounced required one-year annual inspection using the CARE Inspection Tool. Upon arrival at the facility, LPA Haddadin was greeted and granted entry by Caregiver (CG) Tinny Lengkey. Administrator (AD) Cosmin Surgent arrived shortly thereafter.

The facility is licensed to serve five (5) non-ambulatory residents, of which one (1) may be bedridden. The facility also has a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood and consists of one (1) staff bedroom, six (6) resident bedrooms, four (4) bathrooms, a living area, dining area, kitchen, outdoor covered patio, and an attached two-car garage. At the time of the visit, there were four (4) residents in care.

During the inspection, LPA toured the interior and exterior areas of the facility. All bathrooms were observed to be clean, sanitary, and operational. Hot water was tested and measured between 115.9 degrees Fahrenheit and 116.9 degrees Fahrenheit. The kitchen was observed to be clean and organized, with an adequate food supply, including at least a two-day supply of perishable food and a seven-day supply of non-perishable food. Knives and cleaning supplies were secured in a locked exterior cabinet and inaccessible to residents. All kitchen appliances were observed to be operational and in working condition.

Fire extinguishers were observed to be fully charged, with the most recent service date recorded as July 7, 2025. Smoke detectors and carbon monoxide detectors were tested and found to be operational. {***CONTINUE809C***}