Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Tania Tambunan and explained the reason for the visit. Administrators (Admin) Cosmin Surgent and Natalia Surgent arrived approximately 8-9am. LPA observed two caregivers on duty providing care to six residents of which one is under hospice care. The third caregiver was off duty resting in the staff bedroom. The Administrator's Certificate for Natalia Surgent expires on February 10, 2026 and March 12, 2026 for Administrator Cosmin Surgent

The following was observed during the inspection:

This is a single story structure located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. There are six private resident bedrooms, two resident bathrooms, and one private staff bedroom. All common areas were inspected including the two secured sheds in the backyard. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. There were no bed rail orders present for two out of six residents, Resident #1 (R1) and Resident #4 (R4). Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 105.4 and 109.4 degrees Fahrenheit in the resident bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway is free of obstruction. The exit gate was operational and there were sufficient seating and shading. The fire extinguishers were mounted, charged, and serviced on February 7, 2025.