Facility Evaluation Report

On February 13, 2025, at 08:50 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Lilibeth Jacobs, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (5) residents in care and (2) staff members present at the time.

At 9:16 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator.

LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, and a locked cabinet next to the sink with detergents, disinfectants, and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted.

LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair.

LPA inspected the fire extinguisher mounted on the wall in the dining area and found it fully charged, with the last service tag dated 11/08/2024. The Administrator tested the smoke and carbon monoxide detector located in the kitchen area in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

LPA inspected the living room and observed it clean, with all furniture in good repair. There were sofa sets, chairs, a coffee table, a piano, and a television in the living room. (1) resident was observed watching TV. Video cameras were observed in the living room, dining area, and other common areas of the facility, for which the Administrator had obtained signed acknowledgment document from the resident/authorized representative.