Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Tessie's PL #3. The purpose of today’s visit was to conduct the required annual inspection. LPA was allowed entry into the home and met with Caregiver Brian Bayron. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 5 residents and the home currently has 4 residents of which 2 are on hospice care.

LPA Lyman along with Caregiver Jayson Bayron toured the facility at 8:21 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 4 resident bedrooms, 1 resident bathroom, living room, dining room, and kitchen as well as a staff room and 2 shared hall bathrooms. At 8:25 AM, LPA observed unsecured Comet cleaner in the common restroom. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed 1 resident with full bed rails and 2 residents with half rails. LPA observed the bed for Resident 3 (R3) is blocking the exit. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 96.2 and 104.7 degrees F in tested restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. At 8:45 AM, LPA inspected the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed three burners on the stove top are inoperable and staff is using a lighter to start the burners. LPA observed multiple items of spoiled food including zucchini, onion and fruit. Knives are unsecured in a kitchen drawer. LPA observed unsecured pre-poured medications in an unlocked kitchen cabinet. Smoke detectors tested operational during today's visit as well as the Carbon Monoxide detector. Fire extinguisher is charged. At 9:00 AM, LPA observed the exit gate on north side of property has a concrete block and a piece of wood blocking the gate making it inaccessible. The other exit gate is unlocked and self latching. CONTINUED ON LIC 809C DATED 07/09/2026