Facility Evaluation Report

On 11/8/2025 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct and complete the an annual inspection. LPA was greeted by staff and allowed entrance into the facility. Staff contacted Licensee who arrived shortly after. LPA met with Licensee John Nobleza and conducted tour.

LPA observed the facility to be clean, odor free, and clutter free. The facility is currently licensed for 6 and has a current census of 6. LPA observed all emergency exits to be clear and free from obstruction. LPA observed fire extinguishers to be last serviced 7/19/2025 and with current charge. Facility has 7 bedrooms with 2&1/2 bathrooms. 5 of the 7 bedrooms are for resident and the other 2 rooms are for staff. The master bedroom is a shared room with 2 residents, all other residents have their own room. LPA observed resident bedrooms to be properly furnished with adequate lighting. LPA tested the water temperature in the half bathroom which read at 109 degrees Fahrenheit and in the kitchen which read at 109 degrees Fahrenheit. Smoke & carbon monoxide detectors were tested and are in working condition. LPA observed medications to be locked and inaccessible to residents in care. LPA observed a 7 day supply of non-perishable food items and 2 days worth of perishable food items. LPA reviewed infection control plan which is current and up to date. LPA observed a sample of staff files and resident files which are current and up to date. LPA reviewed medications and did not observe any errors at this time.

LPA observed the following deficiencies which were cited under Title 22: Laundry room door was open with unlocked cabinet which made cleaning supplies and chemicals accessible to residents in care. LPA observed 3 residents with full bed rails, 2 of the 3 residents are on hospice. Licensee was not able to provide doctor's order for full bed rail.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were emailed to Licensee John Nobleza.