Facility Evaluation Report

On 1/14/2026 Licensing Program Analysts, (LPAs) LaVette Farlow and Michelle Echeverria arrived at the Nick's Maple Home III, unannounced to conduct an Annual Inspection. LPAs was greeted by Caregiver, Michelle Manaoang. LPAs introduced self and stated purpose of the visit and was granted entry. Caregiver Michelle notified Administrator, Ahmad Abdallatef of LPAs arrival. LPAs were provided space to work, and conducted a tour of the facility. Administrator Ahmad, and House Manager Malik Salem arrived later and participate during the inspection.

Facility: The facility is two (2) story home. It home is a 5 bedrooms, 1 of the 5 bedrooms is for staff, a kitchen, two, (2) living room areas, dining room, laundry space, backyard and attached garage. The facility is approved for a capacity of 10. The facility is approved ten (10) of which eight (8) ambulatory two (2) non-ambulatory. The current census is ten (10). There is a hospice waiver in place approval for 2. The temperature throughout the facility is a comfortable 76 degrees. The facility is equipped with operational smoke alarms, and carbon monoxide detectors. LPA observed two fully charged fire extinguishers. Each one was last inspected October 7, 2025. The facility water was tested and the temperature ranged from 127.9, and 122.3, a technical violation issued.

Resident Rooms - Each resident bedroom can accommodate any ambulatory resident. All resident bedrooms were adequately furnished with bed, storage space, chairs, and lighting.