Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met Jennifer Sandoval, administrator and the purpose of the visit was explained. The facility is licensed to serve residents age 60 and over. Approved for one (1) ambulatory and five (5) bedridden in rooms 1,2,3,5 and 6 only. Hospice waiver approved for six (6).No residents were bedridden. Three (3) residents were in hospice.

Annual visit was conducted using the CARE tools, physical plant, review of food supply/medications/ resident files/ staff files and residents/staff interviews. The facility is in a residential area, a single-story home consisting of six (6) bedrooms, three (3) bathrooms, kitchen, dining room, and living room with a TV. Kitchen was clean and maintain the required two (2) days perishable and seven (7) days non-perishable. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Facility maintains a comfortable temperature of 74 degrees Fahrenheit for residents. Residents' bedrooms furniture in compliance, bed, chair, lamp, dresser. Adequate linen and personal hygiene supply were observed. Dual devices (smoke detector combined with carbon monoxide detectors) were operable and hard wired. Fire extinguishers were fully charged Auditory devices were operable. The last Fire/ Emergency Drill was conducted in October 2025. Outdoor activity area had a shaded patio with ample seating. Med ication /resident files/staff files were centrally stored in a locked storage room and inaccessible to residents.

Administrator certificate was renewed and is pending.

No deficiencies were cited per California Code of Regulations, Title 22.

An exit interview was conducted, and this report was provided to Jennifer Sandoval.