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 six non-ambulatory residents. Facility has an approved hospice waiver for six residents and the home currently has five residents, with two residents on hospice. Staff provided updated liability insurance that expires on 1/04/2027.

LPA along with staff toured the facility at 9:10 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, living room, dining room, one staff room, kitchen, three bathrooms and an attached garage on the first floor. The second floor consists of one bedroom and one bathroom that is rented to a tenant. No residents reside on the second floor. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. At 9:35 AM, LPA observed a bottle of nail polish remover in a unsecured drawer in the bathroom closest to the entrance. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.6 degrees F and 116.7 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. 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. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans. Facility conducts quarterly emergency drills with the last drill conducted on 1/19/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational.