Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 1:15pm. LPA met with Administrator (AD) Ahl Agustin and explained the purpose of the visit.

The facility is a four bedroom, three bathroom residential home with a fire clearance of six non-ambulatory; of which one may be bedridden in room #4. The facility has a hospice waiver for six and one resident is currently on hospice.

During the visit LPA toured the kitchen and observed the refrigerator had more than two days of perishable items and the pantry and freezers had seven days of non-perishable items. LPA observed sharps and knives secured with medications. Hazardous chemicals were secured in the garage. All appliances were in working order and the facility was clean with no odors detected.

LPA inspected the smoke and carbon monoxide detectors and all detectors were operational. Two fire extinguishers were charged and serviced on July 31, 2025. A fire drill was conducted on January 13, 2026. The facility temperature was 76 degrees Fahrenheit. LPA tested hot water temperatures in three of three resident bathrooms. Bathrooms had grab bars and non-skid mats. The hot water temperature ranged between 113.5 to 116.7 degrees Fahrenheit. Resident bedrooms were clean with the required linens and furnishings.

LPA toured the exterior of the property and observed the exterior gate was self-latching and all pathways were clear of obstructions