Facility Evaluation Report

On 8/14/2025, Licensing Program Analysts, Ellen "Triel" Lindstrom and Arvin Villanueva (LPAs) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with staff on duty (S3) and stated the purpose of the visit. The Administrator on record Raymond Gin (S1) was notified and informed LPAs that the Co-Administrator Shiela Seaberg (S2) will assist with the annual because Raymond is currently unavailable. S2 arrived shortly after.

Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 non-ambulatory elderly residents. Facility has a hospice waiver for 2 residents.

Initial Observation: Upon arrival LPAs were greeted by staff on duty (S3). Present during this visit were 6 residents in care with one staff on duty. LPA observed required posters and facility license at the entrance. Room temperature was at 78 degrees Fahrenheit upon arrival.

Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPAs inspected 3 of 5 resident bedrooms. LPAs observed 2 of 3 resident bathrooms. LPAs measured the hot water temperature in the 1 of 3 bathrooms to be at 111 degrees Fahrenheit.

Fire extinguisher was observed in the kitchen area and was last inspected on 5/13/2025. Smoke and carbon monoxide detectors were observed throughout.