Facility Evaluation Report

On 05/02/2025 at 12:45pm, the Department conducted an unannounced annual required visit using the CARE Inspection Tool. The Department met with staff member Elizabeth Gomez (Adminstrator) and purpose of the visit was explained. The facility is licensed to serve residents age 60 and over, of which six (6) may be non-ambulatory, one (1) may be bedridden, and the facility has a hospice waiver for three (3). The facility currently has five (5) residents in care with (1) on hospice & (3) on receiving home health. The facility’s annual fees are current.

The facility administrator’s certificate is Elizabeth Gomez #7017473740 valid 10/25/2024 - 10/24/2026. The facility has liability insurance with Certain Underwriters at Lloyd's (policy #ISCAH0100000189-00) with each occurrence at $1,000,000 and general aggregate at $3,000,000 valid from 11/02/2025 - 11/02/2026

The facility is a two-story residential home located in a residential neighborhood. The licensed facility space is located on the first floor and consists of three resident bedrooms, two bathrooms, a living room, dining room, kitchen, laundry area, activity room, garage/storage area with 2 refrigerator, and a backyard with a shaded area.

On 05/02/2026, between the hours of 12:47pm - 1:00pm, the Department toured the physical plant and observed no bodies of water or firearms/ammunition on the premises. All resident rooms were checked and found to have beds and bedding in good condition, adequate lighting, and sufficient storage space for personal belongings. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly, the shower was free of mold and mildew, lighting was adequate, and sufficient toiletries were accessible to residents. The water temperature properly measured between 105°F -120°F with temperature testing at 117.1°F in kitchen and 105.8 in Bathroom 1.