Facility Evaluation Report

On 3/24/26, Licensing Program Analyst (LPA) Kyle Wellington made an unannounced visit to the facility to conduct an annual inspection. LPA was greeted at the door by the Administrator (Admin), Monina Arjona, who was informed of the purpose of the visit. LPA observed three (3) staff and six (6) residents present at the facility. The census at the facility is six (6) residents. LPA was informed that one (1) resident is currently receiving hospice services at the facility. LPA received a resident roster from the Admin. LPA toured the inside and outside of the facility with the Admin. LPA conducted an observation, interviews and record reviews at the facility for the inspection.

Facility Overview: The facility is a one story house with five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, family room, dining room, laundry room and attached garage. There are no pools, bodies of water or firearms at the facility. The facility has a fire clearance to serve six (6) non ambulatory residents. The facility has an approved hospice waiver for one (1) resident.

Infection Control: LPA observed soap dispensers in the bathrooms and hand sanitizers in the facility. Cleaning supplies were locked in the laundry room and available for regular facility maintenance. LPA reviewed the facility’s infection control plan which met the department’s requirements.

Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The floors, windows and doors were clean and well maintained. The family room and dining room furniture was in good repair. The halls had night lights and were free of obstruction. The residents’ bedrooms were neat, organized and had the required bedding, furniture and lighting. Bathrooms were clean, sanitary and contained paper towels, grab bars and non-slip tile in the showers. The hot water temperature in the