Facility Evaluation Report

On March 25, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, facility administrators Prescilla Mariano and Oscar Samson were present and assisted with the inspection. For this visit, there are three staff members on duty, all of which are background cleared and associated.

The PUB475 ‘See Something, Say Something’ poster was observed to be located in the hallway. LPA observed that Oscar Samson has a valid Administrator certificate which expires on January 13, 2027.

The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and a hospice waiver for six. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of three non-ambulatory residents in care, one ambulatory, four of which are on hospice, and one is bedridden.

The facility is a single story home. There are a total of five bedrooms, two of which are private resident bedrooms, two are shared resident bedrooms, and one is a staff bedroom. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff room is kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of three bathrooms, two are for residents and one is for staff.