Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by Staff Kimberly Serna. LPA met with House Manager Samira Hernandez. LPA contacted Administrator who gave permission for House Manager Samira Hernandez to sign for this report.

A tour of the facility was conducted. The residence was set at 70 F temperature and free of passageway obstructions inside and outside.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked medication cabinet in the laundry room. Cleaning supplies were in a locked closet in the laundry room.

Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 08/25/25. Fire drill 08/15/25. Earthquake drill was conducted 6/14/25. Water temperature measured at 117.4 F.

There was outdoor seating for the residents. No pools or bodies of water.

Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed.

A copy of this report was provided to the House Manager Samira Hernandez.