Facility Evaluation Report

On July 24, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry into the facility by staff, after stating the reason for the visit. Administrator (AD) Theresa Kholoma was contacted by telephone and assisted with the visit. AD was unable to be present and designated Administrator Amelia Morales to sign the report. AD Morales has an Administrator certificate, which expires on October 22, 2027.

The facility is licensed to operate age 60 and over for six (6) non-ambulatory residents, with a Hospice waiver for six (6). The building is a single story structure located in a residential neighborhood, which consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, an outdoor covered seating area, and an attached two car garage. Currently, There are currently four (4) resident on census and present. LPA Bentley toured the inside and outside of the physical plant with staff. All rooms were inspected and the facility was observed to be appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Additional linens, comforters, and bath towels were adequately stocked and available. Bathrooms were found to be clean and operational with water temperatures measured between 114.9 and 119 degrees F. The kitchen was observed clean and there was a two-day supply of perishable and seven-day supply of non-perishable food available. Toxins, disinfectants, sharps, and medications were secured. The backyard was observed with a shaded seating area for residents and the facility has two exit gates that were operational. LPA observed one out of five stove burners non-operation and the facility plans to repair/replace it.