Facility Evaluation Report

On 05/22/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua met with Facility Designated Administrator (FDA), Victoria Kachan and explained the purpose of the visit. The purpose of the visit was to conduct an annual visit.

Current census was 6. A brief interview with FDA Kachan was conducted.

This facility is licensed to serve and retain 6 elderly residents. This facility has a dementia plan on file and a hospice waiver for 6. Bedrooms #1&3 may only have non-ambulatory residents. Bedrooms #2,4,5, and 6 may have bedridden residents. Bedroom #7 is for staff use only.

It was learned that the facility has 1 resident on receiving hospice services.

LPA Pascua reviewed 6 resident files and 6 staff files. All files were complete and up to date. FDA Kachan has an active administrator certificate #7016512740 and expires on 08/05/2026. The facility has conducted a fire drill and disaster training on 04/20/2026.

Fire extinguisher located by the kitchen appeared to have been serviced by the local fire extinguisher company, Cinta, on 02/10/2026 and is in compliance.

The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time.