Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA met with Administrator Designee (AD) Khatera Bahadory at 9:15am and explained the purpose of the visit. AD shared with LPA that AD recently purchased the facility in February 2026 and the facility will be undergoing a Change of Ownership.

The facility is a five bedroom, three bathroom residence with a fire clearance for six non-ambulatory residents in which one may be bedridden in bedroom #2. The facility has a hospice waiver for six residents. Currently there are five residents in care and four were receiving hospice services.

LPA toured the kitchen and observed sharps, knives and chemicals/ cleaning supplies were stored beneath the kitchen sink and were secured. The refrigerator/freezer had more than two-days of perishables, fresh fruits and vegetables were observed, and there was seven-days of non-perishable supplies. LPA observed pantry and there were no items that were expired. The kitchen appliances were in working order. The facility temperature was 70 degrees Fahrenheit, was clean and odorless.

During the tour LPA observed resident bedrooms which had the required furnishings. Bed rail orders were on file. LPA tested the hot water temperatures in two of two resident bathrooms. The hot water temperature ranged from 113.3 to 113.5 degrees Fahrenheit. Bathrooms had grab bars and non-skid mats and covered trash bins. Carbon monoxide and smoke detectors were inspected and were operational. The fire extinguisher was charged and inspected on March 25, 2025. The last fire drill was conducted on February 3, 2026. A Technical Violation was provided for documentation not in the file.