Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Ahmad Ali and explained the reason for the visit. The Administrator's certificate expires on May 4, 2026. Facility is licensed for 6 non-ambulatory of which 1 may be bedridden and a hospice waiver for 4. Facility is a two story home with 5 bedrooms, 5 bathrooms, living room, family room, dining room, kitchen, laundry room and an attached 2 car garage. Administrator Ahmad Ali arrived during the visit. The first floor consists of the family room, laundry room, 3 bedrooms and 3 bathrooms and the garage. The garage is kept locked and used for storage. The second floor consists of 2 bedrooms, 2 bathrooms, the living room, dining room and the kitchen. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA and the Administrator toured the first floor. LPA observed all resident rooms had the required furnishings. LPA observed all bathrooms are clean and operational. Hot water measured 107.7 in the bathrooms on the first level. LPA observed the garage is used to store extra supplies and furniture. The garage is kept locked. LPA observed the fire extinguisher at the base of the staircase is fully charged. No obstacles or hazards observed on the first floor. LPA and Administrator toured the second floor. LPA observed an emergency evacuation chair at the top of the staircase. LPA observed both resident rooms had the required furnishings. Both bathrooms are clean and operational. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The fire extinguisher in the kitchen is fully charged. LPA observed knives are kept locked in a kitchen drawer and medications are kept locked in the kitchen pantry. LPA observed the 5 burner gas stove lights unassisted. LPA did not observe and Administrator verified the facility does not have an internet device dedicated for resident use only.