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 four residents and the home currently has four residents, with no residents on hospice. Administrator (AD) Cynthia Shayamunda arrived shortly to assist with the inspection. AD provided updated liability insurance that expires on 4/06/2026.

LPA along with staff toured the facility at 9:05 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of five resident bedrooms, living room, dining room, and kitchen, two bathrooms and an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed bed rails for three resident beds. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 131.5 degrees F and 134 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Four out of five auditory exit alarms were not 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. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 09/20/2025. Outside grounds were toured.