Post-licensing visit·November 24, 2025

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced post licensing visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Trish Pena. The facility is licensed for 6 residents, 4 of whom may be ambulatory and 2 may be non-ambulatory. The facility has a hospice waiver for 2 residents. LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order and bathroom sinks were compliant temperatures. The facility’s ambient internal temperature was comfortable and complaint. The facility has enough linens, hygiene supplies, cooking and dining supplies. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. All kitchen appliances were in working order. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. LPA reviewed facility records and the files reviewed contained required documents. (CONTINUED ON LIC 809-C, NEXT PAGE) (CONTINUED FROM LIC 809) No pools or bodies of water on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Administrator, no firearms or ammunition are at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Trish Pena, Administrator, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.