Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted facility administrator (AD) Nargis Elahi about visit. AD Elahi designated for staff on duty (S1) Jackelin Mijares to receive and sign report due to AD Elahi being unavailable.

The PUB475 "See Something, Say Something" poster was observed to be located at the entrance of the facility. LPA observed the Administrator's Certificate for Nargis Elahi, which expires on 11/11/2026.

LPA toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 1 may be bedridden in room #1 and 6 may be on hospice. For this visit, there are a total of 5 residents in care, of which 0 are on hospice and 0 are bedridden.

There are a total of 7 bedrooms, of which 6 are private resident rooms, and 1 bedroom for staff. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 2 restrooms, of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 108.8 degrees Fahrenheit.