Facility Evaluation Report

An Annual visit was conducted on the date above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Brian Costa; Assistant Administrator /Registered Nurse (RN) Cynthia Costa. LPA introduced self & purpose of visit.

Physical Plant toured. Kitchen area toured. 2 day supply perishable & 7 day supply non-perishable food observed on the premises. Tight fitting lids on trash cans.

Lobby, front sitting rooms, & dining room sufficiently furnished with sufficient lighting. Furnishing observed to be in good repair & appear to be clean with no unpleasant odors. Resident rooms observed to be sufficiently furnished with adequate lighting. Resident bathrooms appeared to be clean with no unpleasant odors. Grab bars in all toilets, tub, & shower areas. Non-skid mats in tub/showers. Hot water measured at 118 degrees F. Auditory alarms on exits. Outside area toured. No hazards observed. Interior & exterior walkways observed to be clear & free from obstructions.

Medications observed to be organized & stored in locked area. Paperwork maintained. Resident & staff records complete, organized, & up to date. Cleansers, soaps, etc stored in area inaccessible to residents. Smoke & carbon monoxide detectors operational. Fire extinguisher service date: 12/20/2025. Q&A License with updated comments & updated Hospice Waiver approval discussed & provided.

Exit interview conduced with Admin & RN. Copy of report provided.