Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a Required Annual Inspection and met with staff, Maria Butuza, and Administrator, John Butuza. LPA observed (1) resident resting/watching television in their room The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (1) resident. Currently, there is (1) resident who was recently admitted to hospice.

LPA and the Administrator toured the interior/exterior of the facility including common areas, (6) private resident bedrooms, (3) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, skid-resistant flooring, and hygiene supplies. Medications are secured in the common area, and toxins are locked in the laundry area. Sharps are locked in the kitchen. The inside temperature measured 78*F and the hot water measured 110*F in the kitchen. The fire extinguisher was last serviced Feb 26, 2026. One smoke/monoxide alarm was tested and in working order. There are door alarms on the exit doors. The fire extinguisher was last serviced Feb 11, 2025. One smoke/monoxide alarm was tested/sounded. There are door alarms on the exit door. The driveway area is open and can be used for emergency exit. All required postings were observed. There is a patio table outside as well as a vegetable garden.

LPA reviewed (1) resident and (2) staff files. Files were organized and contain current documentation, including care plan. Medications were reviewed for (1) residents- no discrepancies noted and documentation is being maintained. Administrator has current RCFE #7004713740 (exp 6/4/28) and both staff have current First Aid/CPR certifications (exp 1/27). Staff has completed continuing training as required. LPA obtained current liability insurance information. There were no deficiencies observed. Discussed reporting requirements. Exit interview. Copy of report provided.