Facility Evaluation Report

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today August 3, 2026 for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Maria “Alicia” Ortiz.

Facility is licensed for 4 residents and has a current census of 4. There are 0 residents on hospice and 0 with home health. Water temperature was checked in the kitchen and read at 105.3 degrees Fahrenheit. Fire Extinguisher was serviced August 5, 2025 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order.

Alicia’s Administrator Certification expires November 24, 2027. Staff files were reviewed, are complete, and current. Resident files were reviewed, complete, and current. Facility provided a log for disaster drills that are conducted monthly. First aid kit on site. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications. Sample of medication was checked.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable.

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA is requesting the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing August 14, 2026.

Exit interview conducted and a copy of this report LIC809 was provided to Alicia Ortiz.