Facility Evaluation Report

On December 11, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced annual visit. LPA met with Caregiver, Maylene Arboleda and explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility. There are 9 resident rooms, all of which are currently being utilized as single private rooms. Resident rooms were observed to be clean with all required furniture. LPA observed resident room numbers 1, 2, 4, 5, and 7 with beds that have half bed rails and resident room numbers 3 and 6 with full bed rails.

1 staff room was observed. LPA observed 3 full bathrooms and 1 half bathroom inside room #1. Bathrooms were observed clean, odor-free and equipped with grab bars. Water temperature throughout the facility measured between 126-134 degrees F. Extra linen was observed to be present. First aid kit was observed to be complete. Dining room was observed free from tripping hazards. A comfortable temperature of 70 degrees F is maintained and lighting is sufficient for comfort. LPA observed 2-day perishables and 7-day non-perishables. Medications, sharps, and chemicals were observed locked an inaccessible to residents in care.

Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of

October 2025. Emergency drills are logged and done every three months. LPA reviewed 6 resident records including physician's orders for bed rails and reviewed 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. (continue to 809C)