Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 2:05 pm and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Administrator Anna Teresa Tolentino and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care and are locked in a cupboard in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The fire extinguishers were last charged and inspected on 2/25/26. Facility has a Sprinkler that was inspected in June of 2025.

Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance that expires on 12/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6, all 6 can be bedridden and a hospice waiver is approved for 2 residents.

Staffing Records & Training: The facility currently employs 5 caregivers, and 1 administrator. Files reviewed for, but not limited to current 1st Aid/CPR, Personnel Records/Application, and Health screening with TB results. Administrator’s Certificate expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2025 and 2026.