Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. Upon arriving at the facility, LPA met with Mariciel Gamboa, Administrator. LPA explained the purpose of the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents age 60 and above, and approved for six (6) non-ambulatory residents. Facility may retain four (4) hospice residents. Facility have 24 hour awake staff. Currently, all six (6) residents are non-ambulatory. Annual fees are current. Administrator certificate is current and expires on August 2025, renewal was sent in July certificate is pending.

During the visit, the care tool was used, a tour of the facility was conducted, medication was reviewed, staff was interviewed, residents were interviewed, and food supply was reviewed.

The facility is in a residential area. A physical tour was conducted. The facility is a single-story house which includes living room, dining area, attached garage/storage, kitchen, pantry, TV room, four (4) resident bedrooms, two (2) bathrooms and staff office/lounge room. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105-120 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. There are no pools and bodies of water on the premises. There are no firearms on the premises. Facility maintains a comfortable temperature for residents.