Facility Evaluation Report

On 04/03/2025 at 11:30 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator MIchelle Matamoros was informed of the visit. LPA Brown informed Licensee/Administrator Matamoros of the purpose of the visit. At the time of the visit there were two (2) staffs present, and six (6) residents present.

The facility is a six (6) bedroom, three (3) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). LPA Brown noted that the pool in the backyard was locked and with the required fenced. The facility is licensed for a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility’s approved for four (4) hospice waiver. The current census is six (6) residents. LPA Brown was accompanied by Licensee/Administrator Matamoros to conduct a general overall inspection, which included, but was not limited to the following:

Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown noted that there a non-slip mat in residents' shared bathroom. LPA Brown observed sufficient furniture and lighting throughout the facility.***Continuation in LIC809C ***