Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA met with the Business Office Manager, Carmen Hernandez and the purpose for the visit was explained. The facility is licensed for the age range 60 and over and 163 non-ambulatory residents. Currently, the facility has six (6) hospice waiver residents and seven (7) home health residents.

The initial annual visit was conducted on 07/29/2025. During the initial visit the following eight (7) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant Environmental Safety, Resident Rights-Information, Planned Activities, Food Services, Incidental Medical and Dental, Disaster Preparedness.

During today’s annual visit, the following five (5) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Operational Requirements, Staffing, Personnel Records-Training, Resident Records-Personnel Reports, Resident with Special Health Needs.

Operational Requirement: T he current plan of operation is completed. The facility has a Dementia Waiver in place. A Hospice Waiver for 25 residents is approved. A fire clearance approved for 163 non-ambulatory residents. Based on record review, LPA observed that the facility has valid Liability Insurance in place. However, based on record review and observation, the facility has one (1) resident that is bedridden.

Staffing: Facility has sufficient staffing for care and supervision for the residents.