Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced on 01/09/2026 to conduct an Annual Required – 1 yr. inspection to this facility. Monet Santana, LVN, Program Manager welcomed LPA. There are 21 clients currently enrolled.

LPA toured the facility. Licensees/Adminstrators were not on site at the time of the inspection. Sherry Williams Assistant Administrator arrived shortly. Facility was found to be clean and at a comfortable temperature of 72 F with all exits free from obstruction. Clients' activity room, sensory room, bathrooms, kitchen and food storage areas were inspected and found to be clean and sanitary. Clients bring their own lunches each day, which are stored in kitchen area. Staff warm them up and help serve on trays which are wrapped and labeled. Two (2) Fire Extinguishers were found to be charged on 11/15/2025 and 12/18/2025. Carbon monoxide detectors was tested and found to be operational at the time of inspection. The fire sprinkler system is inspected every 6 months. There was a supply of cleaners, hygiene products and other toxins which were stored in a locked cabinet under the kitchen sink and in a locked storage cabinet. Medications and sharps are kept in a locked med cart in the med room area. There are 2 client bathrooms set up with hoyer lifts and large changing tables, which were found to be clean and sanitary. There are also 2 staff restrooms, with a supply of soap and paper towels. Water temperature at all sinks measured between 107.5 and 108.4 which is within regulation. The large Activity Room is supplied with many activities and comfortable seating to accommodate the special needs of the clients. The recently renovated sensory room provided therapeutic and restful sanctuary. The enclosed outside activity area has a table and a swing that can accommodate a wheelchair and a large awning to provide shade. Clients are in an enriching environment that provides social interaction and many activities. The Program was celebrating 4 clients' birthdays on the day of visit,