Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA D. Roman was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator, Connie Escobar. According to the facility’s license, the facility has a maximum capacity of four clients, of whom all may be ambulatory and one of which may be non-ambulatory.

LPA D. Roman toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings (beds, drawers, night stand, and closet space). Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 120 degrees F.

No pools or bodies of water on the premises. Per Connie Escobar, no firearms or ammunition are kept at the facility. Smoke/Carbon Monoxide detectors were tested at 4:15PM, emergency lighting, and facility telephone were all working. Fire extinguishers were present and serviced on 07/05/2025. First aid kits were complete and readily accessible.

Resident records reviewed had required documentation. Staff records reviewed also contained current documentation.

An exit interview was conducted with Administrator, Connie Escobar, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit. Their signature on this form acknowledges the receipt of this report and their rights.