Facility Evaluation Report

On 05/06/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct this facility. LPA met with FDA Tabitha Antonio and explained the purpose of this visit. The purpose of this visit was to conduct an annual visit.

Current Census was 6. A brief interview with FDA Antonio was conducted.

This facility is licensed to serve 6 elderly residents of which all may be non-ambulatory. This facility also holds a dementia plan on file.

LPA reviewed 3 resident files and 3 staff files. All files were current and up to date. The administrator has an active administrator certificate and expires on #7033720740 and expires on 1/17/2026

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 01/19/2025. Smoke Detector and carbon monoxide was observed to be in good repair.

The kitchen area was toured. LPA observed a 7 day non-perishable and 2 perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.