Facility Evaluation Report

On this day, November 13, 2025, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Maria Dolores Floriza, and informed the reason for visit. John Ronald Olivarez, licensee, arrived at around 10:56 am. Licensee left at around 4:30 pm.

LPA started inspection with Maria Dolores Floriza and continued with licensee. LPA inspected the kitchen, dining area, living/tv room, common areas, bathrooms and staff room. LPA randomly selected 5 residents rooms for inspection. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked.

Hot water temperature in lavatory in one of the resident's rooms was tested. Fire extinguishers were observed fully charge with tags showed serviced September 23, 2025. Disaster drill records reviewed.

LPA reviewed 5 staff and 5 residents files, and interviewed 1 resident. Medications checked, and compared with LIC622 Centrally Stored Medication and Destruction Records and doctor's orders. Facility does not handle residents' cash resources.

Copies of the following updated/current documents were obtained on this same day:

1. LIC610E Emergency Disaster Plan (9 pages)