Facility Evaluation Report

On July 21, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Saba Tesfay was notified via telephone and later arrived to assist with today's inspection. LPA observed that Saba Tesfay submitted an Administrator renewal application to the Administrator Certification Bureau (ACB) on May 6, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six residents, of which five can be non-ambulatory and one can be bedridden, and has a hospice waiver for three. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, three bathrooms, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five resident in care and two care giving staff present. LPA observed residents relaxing in the living room and in their respective bedrooms. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 117.1 and 118.2 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care.

LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand in the kitchen. CONTINUED ON 809-C