Facility Evaluation Report

On 03/25/2026, Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to address a complaint that was filed with the Department on 03/17/2026. This case management is not part of the complaint. This case management - deficiencies is based on LPAs observation at the time of the visit. During the visit LPA was accompanied by the designated administrator Philipp Perez. Licensee/Administrator (LIC/ADM) David Devries is not available at the time of the visit due to prior commitment.

The facility is licensed to serve adults age 60 and over with a capacity of 6, of which may be ambulatory and 6 may be non-ambulatory and a hospice waiver for 6. LPA conducted inspection inside and outside, including but not limited to the kitchen, dining area, 4 out 4 resident bedroom, 2 out 2 bathrooms, 1 staff room, exterior perimeters, and interior area of the facility.

During inspection, LPA observed no tripping hazard on the hallways and emergency exits. LPA observed Arm and Hammer laundry detergent and Downy liquid cloth softener not locked in the laundry area that is located in the pass through from the inside towards the garage area and accessible to residents in care. S1 stated one of the resident likes to do their laundry at night that's why they leave the detergents inside the cabinet and not locked. LPA observed a steak knife that was not locked and is accessible to residents in care in the left corner drawer of the counter located in the kitchen. LPA observed the kitchen vent was covered with accumulated oil residue.