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 (AD) Karl Padua and explained the purpose of the visit.

The facility is a six- bedroom, two-and-a-half bathroom, single story home with a fire clearance for six non-ambulatory residents and hospice waiver approved for six residents. The facility currently has a census of six residents in care and four residents on hospice.

During today's visit, LPA toured the facility and tested carbon monoxide and smoke detectors and both were operational. LPA observed a video camera in the common area that does not have audio. LPA observed the fire extinguisher was charged and inspected on November 3, 2024. The facility conducted their last fire drill on December 12, 2025. The facility was clean and there were no odors detected.

LPA inspected the kitchen and all of the stove burners are in working order. Cleaning chemicals and disinfectants were secured beneath the sink and knives/sharps were secured in a drawer. The refrigerator had the required two day perishable items and the pantry had seven days of non-perishables on-hand. Fruits were observed on the counter and, at time of the entry, residents were eating breakfast. Emergency water was in the garage.

While touring the interior LPA observed the PUB 475 posted, as well as Personal Rights, Resident Council information and Visiting Hours. LPA tested two of two resident bathroom water temperatures. The hot water temperatures ranged between 105.3 to 108.1 degrees Fahrenheit. Showers had grab bars and non-skid