Facility Evaluation Report

On February 5, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a case management visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo "Carla" Miranda spoke with LPA via telephone and arrived shortly to assist with the visit.

During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three (3) residents in care with three (3) staff present. Water, electricity, gas, and air conditioning are in operation. Bathroom faucets are verified to dispense hot water between 114.8-116 degrees F. Emergency food and water supplies are available and adequately stocked. LPA conducted interviews with three (3) residents and three (3) staff. Perishable food supply observed adequately stocked, however, there is a limited supply of non-perishable food items in the kitchen. A deficiency is being cited.

The following documentation was requested from facility staff:

- Payroll records for December 2025, January & February 2026

- Grocery receipts for December 2025, January & February 2026

- Utility bills (water, gas and electricity) for December 2025, January & February 2026

- Proof of rent payments for December 2025, January & February 2026

- Resident Records: Emergency Face Sheets, Admissions Agreements, Physician's Reports, Appraisals, and Hospice Records

An exit interview was conducted and a copy of this report, LIC809-D, and appeal rights were provided to Administrator Rosendo "Carla" Miranda at exit.