Facility Evaluation Report

On May 16, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (Admin) John Paul Atencio was present to assist with the facility inspection on today's date.

The facility is licensed for six (6) non-ambulatory residents, one (1) bedridden with approved hospice waiver for six (6) residents. Currently, there is one (1) Hospice resident present during today’s visit.

This is a single story home with a back storage unit no garage facility. The facility has four (4) resident bedrooms ( two shared and two private) and four bathrooms.

At around 12:50PM, LPA conducted a tour of the physical plant accompanied by Caregiver, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 106.3 to 115.7 degrees F. A comfortable temperature of 72 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has a supply of emergency food and water. A fire extinguisher was charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C