Facility Evaluation Report

On 09/30/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with staff member (SM), Antonieta Gimeno and explained the purpose of the visit. Shortly after, LPA met with Facility Designated Representative (FDR), Venice Andrews and Licensee, Marinela Placintar. There was one staff member present, VanScott Smith.

Current census was 5. A brief interview with FDR Andrews was conducted. This facility has a hospice waiver for 2 and a dementia program on file.

LPA reviewed 4 resident files and 3 staff files. All files were complete and up to date.

LPA Pascua toured resident bedroom #1. Resident furniture was observed to be sufficient to meet their needs at this time. LPA Pascua also toured a bathroom connected to resident bedroom #1. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.

LPA Pascua toured the kitchen area. LPA Pascua observed a sufficient amount of 2-day

perishable food supply in the refrigerator and a 7-day non-perishable food supply in the pantry for 5 residents. Knives were observed to be locked and made inaccessible to the residents at this time. Cleaning supplies were also observed to be locked under the kitchen sink and made inaccessible to the residents in care. A fire extinguisher was also observed to be in the kitchen and was annually inspected by Jorgenson Co on 07/16/2025 and is in compliance at this time.

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