Facility Evaluation Report

On January 6, 2026, 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 staff after explaining the purpose for the visit. Administrator (AD) Shimon Cagan was present to assist on today's visit. LPA observed that Shimon Cagan has a valid Administrator certificate which expires on November 21, 2027.

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, three resident bathrooms, two of which are shared, a living room, a den, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the physical plant. On today's visit, LPA observed four residents in care, one of which is receiving hospice care, and two caregiver staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected all five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.5 and 111.5 degrees Fahrenheit.

LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives and sharps are stored in a locked kitchen cabinet. CONTINUED ON LIC809-C