Facility Evaluation Report

On July 30, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct an annual inspection utilizing the CARE tool. LPA met with caregiver and explained the purpose of visit. Caregiver then contacted Administrator who arrived to the facility shortly afterwards. Today's census is five residents in care, with one resident on hospice services. Facility is licensed for six non-ambulatory, hospice waiver of one.

LPA and Administrator conducted a tour of the interior and exterior of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: six private residents room, bathrooms, laundry room, storage, kitchen, backyard and the common areas. LPA observed active Administrator Certificate #7002556740 posted. LPA observed facility to be cooled at a comfortable temperature of 72*F. LPA observe pool gate to be locked and inaccessible to residents in care. LPA observed medication cart to be locked. LPA observed laundry detergents to be locked in cabinet in the laundry room. LPA observed facility to have ample supply of linens. LPA observed storage room to have at least two days of perishable foods and seven days of non-perishable foods. LPA observed knives to be locked in a secured space. LPA observed fire extinguisher to be recently serviced on December 7, 2024. File review was conducted for three residents and three personnel records. LPA observed files to be complete with the required documents. File review was conducted for facility's Emergency Disaster Plan and Fire Drills.

LPA and Administrator discussed requesting a new fire clearance. LPA informed Administrator to submit a new LIC 200 and facility sketch to facility's assigned analyst.

Inspection tool was completed and no deficiencies was cited.

Exit interview was conducted and a copy of the report was provided.