Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with caregivers, Keisha Collins and Gabby Mais. The administrator was contacted by phone and arrived around shortly. The facility is licensed for (5) residents, all of whom may be non-ambulatory. There is an approved hospice waiver for (2) residents. Currently, there are (0) residents under hospice care. LPA observed (1) resident return at the end of the inspection. (1) resident is currently at skilled nursing.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (1) private resident bedroom, (2) shared resident bedrooms, (2) resident bathrooms with showers, kitchen, office and garage/laundry area. The facility was clean, in good repair and odor-free. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and medications are secured nearby. There are additional toxins locked in the garage/laundry area. Inside temperature measured 73*F and hot water measured 112*F in a bathroom. The fire extinguisher was last serviced on 3/5/25- facility will have it serviced by 3/6/26. The smoke/monoxide alarms are working. Last disaster drill was conducted in January 2026. First Aid kit is complete. There are sufficient towels, linens, blankets and incontinent products. There are activities/games and sufficient indoor/outdoor space. There are no pools. There is (1) unlocked exit gate and outdoor shaded seating. All exits doors and windows have alerts, and there are no blockages to any doors. Additionally, staff are aware of where the utility shut offs are located. There are multiple postings are in the common area, including an updated Resident Rights poster.

(2) resident files and (7) staff files were reviewed. Files are organized and have current documentation, including care plans and staff training. Medications were reviewed for (1) resident- no discrepancies were noted. Administrator certificate #7010092740-exp 3/16/27. Infection Control Plan and Dementia care plan were reviewed annually. There are no citations issued in this report. Exit interview. Copy of report provided.