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) Wilma Fuentes & Jonalyn Mejia about visit. For this visit, there are 2 staff members on duty, of which are background cleared and associated.

The PUB475 "See Something, Say Something" poster was observed to be located at the entrance of the facility. LPA observed the Administrator's Certificate for Wilma Fuentes which expires on 1/4/2027 and Jonalyn Mejia which expires on 12/6/2026.

LPA toured the interior and exterior portions of the facility with staff on duty. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 1 may be bedridden (in room #2) and 6 may be on hospice. For this visit, there are a total of 5 residents in care, of which 4 are on hospice and 0 are bedridden.

There are a total of 6 bedrooms, of which 4 are private resident rooms, and 1 shared resident rooms and 1 room for staff. 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. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 2 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 118.9 degrees Fahrenheit.