Facility Evaluation Report

On 1/27/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit. LPA was greeted by Administrator Nelly and explained to Nelly the purpose of the visit. LPA Flores conduced a tour of the facility alongside Administrator and was advised that the facility current does not retain any residents. During the visit, LPA observed the following:

The facility is a single-story structure which consisted of (3) three resident bedrooms, (1) staff bedroom, (4) four bathrooms, living room, great room, formal dining room, kitchen, and garage. LPA observed an additional guest house which will not house any residents. All indoor and outdoor passageways were free from obstruction. The facility maintained a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. Emergency food and water supply is present. There is a location for sharps in the kitchen. Resident bedrooms were equipped with the required bedding, furniture, and functional lighting. Bathrooms were observed to maintain the required grab bars and slip resistant materials. Food prep areas are sanitary and organized. The carbon monoxide and smoke detectors were observed to be fully operable. Medication is anticipated to be centrally stored in a locked cabinet located in the kitchen. Per Administrator, there are no firearms and/or ammunition on the premises.

LPA observed the required posting of the PUB475, LTCO, personal rights, and license. LPA was unable to review resident records due to there not being residents. LPA was unable to review staff records as there are no additional staff employed. LPA observed a locked file cabinet in the great room which will store potential resident files. Nelly Custodia Administrator Certification expires on 10/23/2026. During the visit, LPA did not observe any health and safety concerns.

An exit interview was conducted and a copy of this report was provided to Administrator.