Facility Evaluation Report

On 05/07/2025, Licensing Program Analysts (LPA) Triel Lindstrom and Arielle Pascua arrived at the facility to conduct an unannounced annual inspection. LPAs Lindstrom and Pascua identified themselves, explained the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). DFA Jacob Harryman (Administrator Certificate # 6071704740, expiration date 07/30/2026) was on-site and a brief interview followed. DFA Harryman led LPAs Lindstrom and Pascua on a tour of the facility and accompanied LPAs on their inspection of interior and exterior areas of the facility.

This facility is a four-story apartment building that is licensed to serve 78 residents, including 59 nonambulatory and 19 ambulatory individuals. The facility offers licensed care on the first through third floors, including memory care on the first floor and assisted living on the second and third floors. The fourth floor is independent living. It has a hospice waiver for 6. Its fire clearance was issued by Angels Camp Fire Department on 02/08/2021. The current census is 50 residents in licensed care.

The annual inspection began with a records review. LPA Lindstrom requested and reviewed three resident files and five staff files. Each staff file contained the required documentation, including First Aid/CPR certification, criminal background clearance, and TB test results. Each resident file contained the required documentation, including ofpre-appraisals, admission agreements, and physician reports.