Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Eva De Lazo and the purpose of the inspection was discussed. Assistant Administrator (AAD) Laura Oudinot arrived at approximately 1:30 p.m.

During the inspection, LPA and AAD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a two-story home with four resident bedrooms, two bathrooms, and attached two-car garage on the first floor. The second story is used solely as staff quarters. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 118.9 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated July 21, 2025. Gas stove, microwave, laundry washer and dryer were inspected and all, with the exception of the gas stove, were observed to be operable. Gas stove was observed to require a multi-purpose lighter in order to operate; a Deficiency was cited on today's date. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA conducted record review of five resident files and three staff files. LPA interviewed residents and staff. (Cont. LIC809-C)