Routine inspection·December 9, 2025

On December 9, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee Evelyn Wallace was notified via telephone and later arrived to assist with the inspection. LPA observed that Evelyn Wallace has a valid Administrator certificate which expires on August 10, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single story home with four resident bedrooms, two of which are shared, one staff bedroom, three resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the four resident bedrooms and observed them to be clear of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in resident bathroom. LPA inspected the three resident bathrooms and observed them to be clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.5 and 109.1 degrees Fahrenheit. LPA observed the facility has a two day perishable and a seven day non-perishable food supply in the kitchen. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C LPA observed a fire extinguisher to be mounted on the wall in the resident hallway and it was observed to be charged and up to date on service. LPA tested the individual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility did not have any documented emergency disaster drills in the year of 2025. LPA observed the centrally stored medication to be kept in a locked cabinet in the kitchen. LPA observed there is also a First Aid kit stored in the cabinet which has all the required components. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the LI, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be clear of any obstructions or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate to be self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed the residents' medication and medication administration records. LPA observed the facility was providing six over the counter medications to Resident #4 (R4) without a physician's order. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D. An exit interview was conducted with Licensee Evelyn Wallace. A copy of the report and Appeal Rights were provided.