Facility Evaluation Report

Licensing Program Analysts (LPAs) Garlli Tat and Celine Rodriguez conducted an unannounced visit for the Required 1 Year Inspection. LPAs explained the purpose of today’s visit, and were greeted and granted entry by staff on duty (S1) Carmen Rivas, who also notified facility administrator (AD) Paul Smith about visit.

For today’s visit, LPAs observed a total of five residents in care and three staff members on duty, of which current staff are background cleared and associated.

LPAs observed the Administrator's Certificate for Paul Smith which expires on June 17, 2026. LPAs observed the PUB475 "See Something Say Something" poster located in the hallway.

LPAs toured the interior and exterior portions of the facility with S1. The facility is a one-story structure and is licensed for six non-ambulatory residents, of which three may be on hospice and zero bedridden. There are a total of six bedrooms, of which 1 is a shared resident room, 4 private resident rooms, and 1 is a bedroom for staff. LPAs 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 detectors and auditory exit alarms were tested and operational. There are a total of five bathrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were observed. Water temperature was tested to be 105 degrees Fahrenheit.

Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged and located in the kitchen. Fire extinguisher tagged and dated for February 2025.