Facility Evaluation Report

On December 23, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensee (LI) Alan Shelley was notified via telephone and later arrived to assist with the inspection. LPA observed that Alan Shelley has a valid Administrator certificate which expires on March 24, 2027.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a single-story home with six private resident bedrooms, one staff bedroom, two shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA accompanied by the LI conducted a tour of the physical plant. On today's visit, LPA observed six residents in care and two caregiver staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the kitchen. LPA inspected the six resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Hot water temperature measured between 117.5 and 118.6 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care.

LPA observed the kitchen has a two day perishable and seven day non perishable food supply on hand. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C