Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Margie Isidro and explained the purpose for today’s visit. The facility is licensed to serve 6 Ambulatory Adults Age 60 and over, (2 of which may be non-ambulatory in Room #1, 1 non-ambulatory in room #2, 2 non-ambulatory in room #3, and 1 ambulatory). There is a Hospice waiver for 2 residents.

The facility is a single-story home located in Bellflower, Ca. A tour of the facility includes: 4 bedrooms (2 of which are vacant), 2 full bath (1 full bath is inside room #1), 1 1/2 bath, living room, dining area, kitchen, attached garage with laundry, front yard and back yard. There is an ADU in the back yard that Administrator resides in, there are no residents living in ADU.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit observed the following:

Infection Control: Facility maintains the required Infection Control Plan.

Operational Requirements: There's an approved fire clearance and maintain the required liability insurance.

Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents.

Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.

Residents with Special Health Needs: There currently are no residents on hospice at the facility.

Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman.

Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Last fire/earthquake drill was conducted on 9/18/25. (Continued on LIC809-C)