Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on

02/00/2024. LPA was met by Caregiver Baltazar Reyes and explained the purpose of the visit. The facility is licensed to serve six (6six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for two (2).

LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street and consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory device on entry of door to be operational, sliding door and exits.

Front Yard: Front yard is well maintained, and no hazards were observed.

Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed centrally stored medications in kitchen cabinet to be locked during visit. LPA Ramirez observed sharps and knives near kitchen cabinet to be locked during visit. First aid kit was observed in kitchen cabinet. Emergency food supply was stored in kitchen pantry.

Dining Room/Living room/: LPA Ramirez observed plenty of lighting and seating in this area. LPA Ramirez observed several recliners in living room area. One (1) large dining room table with six (6) chairs was observed.

Laundry room: LPA Ramirez observed laundry detergent to be locked during visit.

Linen Closet: Contained plenty linens, towels, and hygiene products.