Facility Evaluation Report

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Cheryl Sansano was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Cheryl Sansano has a valid Administrator certificate on June 19, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for six. The facility is a two story home with four resident bedrooms, two of which are shared, two shared resident bathrooms, two staff bedrooms, one staff bathroom, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, one of which is on hospice, and three staff present. LPA observed residents relaxing in their respective bedrooms and in common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the four resident bedrooms and they were observed to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms. Resident bathrooms were clean. Resident bathrooms were equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 125.7 and 128.4 degrees Fahrenheit. The second story of the facility has two staff bedrooms and one staff bathroom. LPA observed the second floor of the facility to be for staff use only and off limits to residents in care. LPA observed staff bedrooms to be kept locked and inaccessible to residents in care. CONTINUED ON 809-C