Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Co-Administrator Jennifer Fernandez. The facility's license shows a maximum capacity of six (6) residents, one (1) of which may be bedridden. Bedridden may only reside in bedroom #2. Additionally the facility is approved for 2 hospice waivers. During today’s inspection there were zero (0) residents in care. Per Co-Administer Fernandez, the facility has not had any residents since the end of March 2025, however the plan is to eventually have the facility operating with residents in the future.

LPA and Co-Administrator Fernandez toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. No furniture was present in the facility however as floors were being redone. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at accessible taps were all compliant: kitchen sink was 110.4F. Hygiene supplies were present, as well as Personal Protective Equipment.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. As the facility currently has no residents, no perishable or non-perishable foods were present. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to potential/future residents.