Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced 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. For this visit, there are 6 residents in care, of which 3 are on hospice. For this visit, LPA Rodriguez met with house manager (S1) Efrain Matheus.

LPA Rodriguez observed the facility administrator (AD) certificate for Hermelinda Perez which expires on 10/30/2026. LPA Rodriguez observed that the PUB475 "See Something, Say Something" poster was posted at the entrance of the facility.

The facility has a total of 6 bedrooms, of which all 6 are private resident rooms. 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. Facility was observed to have 3 bathrooms, of which 2 are located inside the facility, and 1 outside, however it was verified that the bathroom located outside is not for resident use. Bathrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational.

Hot water was measured at 112.3 degrees Fahrenheit. LPA Rodriguez observed that the facility had a two-day supply of perishables and a seven-day supply of non-perishable food. LPA Rodriguez observed hallways were free of obstructions.