Facility Evaluation Report

On 5/29/2026 at 08:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Serrano met with Administrator Manzoor Massey and was granted entry to the facility. At the time of the visit there was one (1) staff present, and five (5) residents present.

The facility is a five (5) bedrooms, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and two (2) hospice waiver and 1 maybe bedridden resident and the current census is five (5) residents. LPA was accompanied by Staff #1 to conduct a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 116 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms.. Fire extinguisher were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws were posted in a common area. Facility does not have an updated infection control plan, disaster drill and emergency disaster plan onsite. Facility does not have non-lip mat in the bathrooms. Deficiencies issued.