Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregivers, Aneitta Simpson and Sherene Brown. House Manager, Kelly Conley arrived shortly to the facility. LPA observed (1) resident watching television in the common area. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver approved for (3) residents. Currently there is (1) resident on hospice.

LPA and House Manager toured the interior/exterior of the facility including the common areas, (6) resident bedrooms, (4) resident full bathrooms and (1) resident/staff bathroom, kitchen, laundry area and garage. All but (1) resident room has an exit door to the outside. LPA observed the facility to be clean, in good repair and odor-free and the bathrooms to have the necessary grab bars, skid-resistant flooring, There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food, and locked sharps in the kitchen. Locked medications are secured nearby. LPA observed locked toxins in the garage/laundry area. Inside temperature measured 70*F. Hot water measured 118*F in a resident bathroom and 125*F in the kitchen- a sign was posted. The temperature will be lowered in the next day. The fire extinguisher was last serviced 5/6/2025, and the smoke/monoxide alarms are working. RCFE Administrator Certificate #7018479740- exp 2/26/27. There is (1) unlocked gate, covered seating and no bodies of water/pool. There are no blockages to exit doors, and staff are aware of where the utility shut off valves are located.

LPA reviewed (2) resident files and medications for (1) resident. Files are organized and contain the required documents. Medications are being administered per orders. (5) staff files were reviewed- all staff are completing the required training, including First Aid/CPR certifications. All staff is fingerprint cleared/associated. LPA obtained a copy of the LIC500 and current liability insurance. An LIC308 will be emailed by 2/3/26. There are no deficiencies issued in this report. Exit interview. Copy of report