Facility Evaluation Report

On May 13, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct 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) Shimon Cagan was present and assisted LPA with the inspection. LPA observed that Shimon Cagan has a valid Administrator certificate which expires on November 21, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a single story home with five resident bedrooms, one of which is shared, two shared resident bathrooms, a living room, a dining room, a kitchen, a laundry room and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five residents in care and three care giving staff present. LPA observed residents participating in a dancing and music activity. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and they were observed to be free of hazards. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 107.6 to 108.5 degrees Fahrenheit.

LPA observed the kitchen has a two day perishable and a seven day non perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON 809-C