Facility Evaluation Report

On January 5, 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 (AD) Mae Ortiz arrived to assist with the facility inspection on today's date.

The facility is licensed for six (6) non-ambulatory residents, of which one (1) may be Bedridden with approved hospice waiver for six (6) residents. Currently, there are zero (0) Hospice residents present during today’s visit.

Facility is a two story home with an attached locked two car garage used for storage. The facility has six bedrooms, (two shared resident rooms, two private rooms and two upstairs rooms for homeowner) and three bathrooms (two for resident use). Upstairs are living corridors for homeowner and residents do not have access to upstairs rooms.

LPA conducted a tour of the physical plant accompanied by Administrator Mae Ortiz, 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. Bed linens were available during the visit. Bathrooms were operational with water temperature measured between 106.5 to 113.7 degrees F. A comfortable temperature of 75 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, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained. CONTINUED ON 809C