Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the home currently has 2 residents, with 1 resident on hospice. Administrator (AD) Joselito Rivera arrived shortly to conduct facility tour. AD provided updated liability insurance that expires on 2/16/2026. AD certificate expires on 10/3/2026.

LPA along with AD toured the facility at 9:05 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 4 resident bedrooms, living room, dining room, staff room and kitchen as well as 2 bathrooms on the first floor. The second floor consists of 3 bedrooms and living room used by the AD. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure. At 9:30 AM, LPA observed shower floor dirty with stains, transfer chair with rusted wheel brackets, and cleaning power in unlocked cabinet in resident bathroom. Water temperature measured 115.7 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. At 9:45 AM, LPA observed furniture blocking sliding door exit access in rooms 3 and 4. Three auditory exit alarms were non-operational. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. Outside grounds were toured. At 10:00 AM, LPA observed clutter in the backyard including an old mattress, other large items designated for removal as stated by AD, and various small items stacked around the house which can be difficult to navigate through. There is plant overgrowth along one of the exit paths covering a large portion of concrete.