Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. Administrator, Aida Urena was contacted who stated to be currently on vacation during the day of visit and unable to meet LPA. LPA met with designated Administrator/House Manager, Deysi Serafin.

During visit, LPA toured the facility with staff to include 3 resident bedrooms, 2 bathrooms, kitchen, living room, garage and backyard. The shed in the backyard was observed and no issues were noted. The backyard is equipped with a shaded seating area. 2 staff members present are fingerprint cleared and associated to the facility.

Facility temperature maintained at 71 degrees F. Fire extinguisher observed in the kitchen area. Carbon monoxide detector in the kitchen area observed operable. Resident bedrooms are equipped with proper furniture and adequate lighting. Bathroom hot water temperature maintained at 117 degrees F. Kitchen is equipped with at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 38 degrees F. Freezer temperature maintained at 0 degrees F. Cleaning solutions stored in a locked separate cabinet from the food supply. Sharp objects and medications observed locked.

LPA reviewed 5 resident files. Based on record review, 1 resident (R5) who was admitted on 07/02/2025, file did not include an admission agreement, needs and services plan, functional capabilities assessment, consent forms, safeguard of personal properties and valuables, and personal rights. Page 1 of 3.