Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents of which one may be bedridden. Facility has an approved hospice waiver for four residents and the home currently has five residents, with one resident on hospice. Administrator (AD) Rita Lee arrived shortly to assist with facility tour.

LPA along with staff toured the facility at 1:50 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of two floors with three staff rooms and one bathroom on the second floor and five resident bedrooms, living room, dining room, kitchen, three bathrooms and an attached garage on the first floor. No resident resides on the second floor. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured at 114 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 2/4/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents.