Facility Evaluation Report

On July 6, 2026, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator/Licensee Pauline Khiev was available to assist with the facility inspection.

The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently, there are three (3) Hospice residents present during today’s visit.

This is a single story with a detached garage facility. The facility has four bedrooms (two shared resident rooms and two private rooms), and three bathrooms.

LPA conducted a tour of the physical plant accompanied by Administrator/ Licensee Pauline Khiev, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bathrooms were operational with water temperature measured at 112.4 degrees F. A comfortable temperature of 76 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishables and seven day non-perishable food was maintained. Facility has supply of Emergency food and water. Facility has two fire extinguishers which was mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and six files reviewed.