Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced visit for the required annual inspection. LPA Rodriguez explained the purpose of today’s visit, and was greeted and granted entry by staff on duty, who informed facility administrators (AD) Olga Moreno and Cristo Forero about visit.

For today’s visit, LPA Rodriguez observed a total of 4 residents in care, of which 1 is on hospice and 3 staff members on duty.

LPA Rodriguez observed the Administrator's Certificate for Olga Moreno which expires on 12/18/2026 and Cristo Forero which expires on 6/26/2026. LPA Rodriguez observed the PUB 475 "See Something Say Something" poster located in the hallway.

LPA Rodriguez toured the interior and exterior portions of the facility with staff on duty. The facility is a two level structure and is licensed for 4 residents of which 1 may be on hospice. On the first level, are a total of 2 bedrooms of which both are shared resident rooms, and 1 bathroom. On the second level, there are 3 rooms designated for staff and 2 bathrooms. LPA Rodriguez confirmed and observed that there are no residents residing on the second floor, and the second floor bathrooms are not for resident use.

LPA Rodriguez 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. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was tested and observed to be at 112.1 degrees Fahrenheit.