Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Caregiver Zlota Levine and was granted entry into the facility. The facility is licensed to serve six (6) residents; of which five (5) can be non-ambulatory, two (2) receiving Hospice services, and one (1) resident may be bedridden. All five (5) Residents were present during the visit.

During today's visit LPA Correia, accompanied by Caregiver Meza conducted a facility tour. LPA observed smoke and carbon monoxide detectors were present and operable. The fire extinguisher was last inspected on April 3,2025. The internal ambient temperature was comfortable and within regulation. The required posting were appropriately displayed, and the facility had a working land line. Sharps, toxins, and medications were locked and inaccessible to Residents in care.

An overall inspection of the facility began today however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection.

No deficiencies were cited during today's visit. This report was discussed with Caregiver Meza A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.