Facility Evaluation Report

On 11/14/25 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Administrator, Dale Martinez, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. Currently the facility does not have any residents.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced on 05/22/2025. Resident rooms observed to have the required furnishings and with adequate lighting. No deficiencies cited during todays visit.

LPA requested the following documents to be submitted to CCL by 11/21/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500) in order to update the facility file.

Exit interview was conducted with Administrator, Dale. A copy of this report provided.