Facility Evaluation Report

Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual visit. LPA met with Manager Mary Jane Estiller, and informed her of the purpose of the visit. Facility is approved for six (6) elderly residents, ages 60 and above; all whom may be non-ambulatory; in which one (1) resident may be bedridden in bedroom #3 or #5. Facility has a hospice waiver for six (6) residents.

The facility is one-story with five (5) bedrooms and one (1) bathroom. LPA inspected the facility inside and out. The front entrance, interior and exterior surroundings were inspected and observed to be clean and in good repair with no pathway obstruction; facility's temperature throughout the facility measured at 75 degrees. Facility's water temperature measured at 105 degrees. The bathroom was inspected and observed to be clean with working toilet and sink. There is sufficient lightings and mattress pads in all of the residents’ bedrooms. Smoke and carbon monoxide detectors were inspected and found to be in working order. LPA inspected the fire extinguishers and they were found to be in compliance. Cleaning solutions were observed in a locked secure area. There were no bodies of water observed on the premise. The facility does not have firearm and/or ammunition on grounds.

LPA observed the kitchen area and there are 7 day non-perishable and 2 day of perishable food items was observed and found to be properly stored. All required postings are posted in the hallway area of the facility. Staff records were reviewed. All staff present have a criminal record clearance on file and are properly associated to the facility.

Random resident records were reviewed. LPA observed they had the required documentation and physicians reports are up to date. LPA inspected medications and medications appear to be dispensed appropriately according to the physician's orders. Last fire drill was conducted in June 2025.

No deficiencies were observed during today's annual inspection. An exit interview was conducted and a copy of the report and LIC 811 was provided to Manager Mary Jane Estiller.