Facility Evaluation Report

On 4/8/25 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived unannounced for an annual inspection visit. LPA was met by Direct Support Professional, Angelica Palomares and Direct Support Professional, Isiah Ramirez. LPAs introduced self, explained reason for visit and was permitted entry into the facility. Administrator, Jose De La Cueva was contacted and arrived some time later.

LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. Residents observed in common areas and in rooms. Pathways and doors inside facility were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 5/15/2024. Last fire drill on 3/28/25. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Medications were located in locked cabinet in the kitchen.

LPA requested the following documents to be submitted to CCL by 4/11/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview completed with Administrator, Jose. A copy of this report, deficiencies and appeal rights provided.