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 administrators (ADs) Olivia Kovac & Khojesta Azizi about visit. Per record review, current staff are background cleared and associated to the facility.

The PUB475 "See Something, Say Something" poster was observed to be located at the entrance of the facility. LPA observed the Administrator's Certificates for Olivia Kovac which expires on 2/19/2026, & Khojesta Azizi which expires on 7/17/2026.

LPA toured the interior and exterior portions of the facility with ADs. The facility is a two level structure and is licensed for 6 residents, of which 6 may be non-ambulatory, 0 may be bedridden and 4 may be on hospice. For this visit, there are a total of 3 residents in care, of which 0 are on hospice and 0 are bedridden.

On the first floor, are a total of 6 private resident bedrooms. 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. On the first floor, there are a total of 5 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 114.9 degrees Fahrenheit. LPA observed a kitchen on the first floor, and observed that smoke and carbon monoxide detector and auditory exit alarms were tested and operational.