Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Dan Mititi, Administrator. Caregiver, Annette C. was also present. LPA observed (1) resident in the common area and (2) residents in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently, there is (1) resident on hospice.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen, laundry area, and office area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. There is sufficient 2+ day perishable and 7+ day non-perishable supply of food. Sharps are locked in the kitchen, medications are locked in the office area, and toxins are locked in the laundry area. The inside temperature measured 73*F, and the hot water temperature measured 115*F in the kitchen. Facility conducts fire drills every two months- will vary type/time of drill. Smoke/monoxide alarms are working. Fire extinguisher last serviced 10/11/24. There are sufficient towels/linens/PPE/paper products and a complete First Aid kit.. Facility license and other required postings are in the common area- Resident Rights and Rights of Resident/Family Councils posted in the common area. There is (1) unlocked gate, covered patio seating, and an empty pool that is locked/gated. LPA reviewed (3) resident files and (3) staff files. Files were organized and complete with current documentation, including required training. Administrator RCFE certificate is current through 11/10/25. Medications were reviewed for (1) resident- orders matched medications being administered and documentation is current. Discussed Guardian/staff updates. Discussed recent regulation changes and updated Dementia Plan of Operation. Liability insurance is current. There are no deficiencies issued in this report. Exit interview. Copy of report provided.