Facility Evaluation Report

On August 4, 2025, at 3:15pm, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Michelle Franco. Administrator (AD) Carmen Rodriguez later joined the inspection and was present during the inspection. LPA stated the purpose of the visit and requested Resident/Staff rosters and Personnel Record.

The facility is licensed to operate for six (6) non-ambulatory residents, of which one (1) may be bedridden, and has a hospice waiver for three (3) residents. The facility is a single-story building located in a residential

neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, two living room areas, dining area, kitchen, an outdoor covered seating area, and an attached two car garage.

LPA Bentley toured inside and outside of the physical plant with AD Rodriguez. There are no obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperature measured 109.0 degrees F to 112.6 degrees F.