Facility Evaluation Report

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Abigail Lopez, who was informed of the purpose of the visit. Administrators Shelly Yashamiro and Xiomara Valencia arrived thereafter.

The facility’s fire clearance is approved for six (6) residents age 60 and over, including up to six (6) non-ambulatory residents, of whom one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents.

At the time of inspection, four (4) residents were under hospice care.

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Required “Oxygen in Use” signage was posted in visible locations throughout the facility in accordance with safety requirements.

The facility is in a residential neighborhood and is a single-story home consisting of four (4) resident bedrooms, three (3) bathrooms (one of which is a private shared bathroom), a living room, kitchen, dining area/tv room, a caregiver corridor and restroom located prior to entering the attached garage, front yard, and backyard. All bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. LPA observed that cleaning supplies and other toxic substances were accessible to residents and located under the kitchen sink without a lock. During LPA’s visit, the administrator secured the cleaning supplies and toxic substances in a locked cabinet located in the kitchen.