Facility Evaluation Report

On October 16, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrators Natalia Surgent and Kevin Surgent were available to assist with the facility inspection.

The facility is approved for licensed capacity for six (6), five (5) non-ambulatory residents, one (1) bed ridden with approved hospice waiver for three (3) residents. Currently, there are two (2) Hospice residents present during today’s visit.

This is a single story with attached garage facility. The facility has six bedrooms ( four private resident rooms, one shared resident room and one staff room), three bathrooms, kitchen, dining area and living room.

LPA conducted a tour of the physical plant accompanied by Administrator Natalia Surgent, Kevin Surgent, Staff Daniela Usurela, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 118.9 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained adequately. CONT ON 809C