Facility Evaluation Report

On 12/4/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility to conduct the annual inspection visit. LPA met initially met with the Administrator Assistant, Mary Jan Mitchell (S1), and stated the purpose of the visit.

Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory. Facility has a hospice waiver granted for 6 residents. Facility does not have bedridden clearance. Facility does not manage residents cash resources.

Initial Observation: Present were 5 residents with 3 staff on duty. LPA observed required posters and facility license. Visitors from outside agencies and some residents’ family members were also present during this visit. Other residents were doing exercise with staff. Room temperature was at 74 degrees Fahrenheit upon arrival.

Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 4 of 6 resident bedrooms and the 2 of 3 bathrooms. LPA hot water temperature was at 112 degrees Fahrenheit. Resident bathrooms were observed to be clean and in good repair at this time.

Fire extinguisher was observed in the kitchen area and was last inspected on 1/22/2025. Smoke and carbon monoxide detectors were observed throughout. LPA observed centrally stored medications, toxins, sharp objects and other dangerous items were kept locked and inaccessible to residents in care.