Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with staff, Annette Cotterell and Alexa Mititi. Administrator, Dan Mititi, arrived shortly. LPA observed (1) resident in the common area, (2) residents in their rooms at the start of the inspection, and a fourth resident move in during 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. 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 and hygiene supplies. There is sufficient 2+ day perishable and 7+ day non-perishable supply of food. Sharps are locked in the kitchen, and medications and toxins are secured nearby. The inside temperature measured 72*F, and the hot water temperature measured 105.3*F in the kitchen. Disaster drills are conducted every two months, and the type/time of drill is varied. Smoke/monoxide alarms are working. Fire extinguisher last serviced 10/15/2025. There are sufficient towels/linens/blankets. Required postings are visible in the common area. There is (1) unlocked gate, covered patio seating, and the pool is locked/gated. Updated copy of liability insurance obtained. `

LPA reviewed (2) resident files and (3) staff files. Files were organized and complete with current documentation, including required staff training. Staff to begin their ongoing required annual training this month. Administrator RCFE #700176270 (exp 11/10/27). Medications were reviewed for (2) residents- orders were very current and matched medications being administered. Annual fees were paid recently.

There are no deficiencies issued in this report. Exit interview. Copy of report provided.