Facility Evaluation Report

On 03/19/26 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA contacted Managing Member, Jose De La Cueva, and was informed they would be on their way shortly. Administrator arrived some time later. LPA explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. There were no residents present during todays visit.

Pathways and doors were clear and free from obstruction inside the facility. 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 03/11/26. Last fire drill on conducted on 2/12/26. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas. No deficiencies cited during todays visit.

LPA requested the following documents to be submitted to CCL by 03/27/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), current copy of liability/surety insurance in order to update the facility file.

Exit interview was conducted with Administrator, Jose.A copy of this report was discussed and provided.