Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 04/29/2024. LPA was met by Caregiver Venus Calzado and explained the purpose of the visit. Administrator Michelle Aguirre arrived shortly after to assist with the visit. Facility is licensed to residents 60 years old and above. The facility is approved for 6 non-ambulatory. The facility may retain four (4) hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), copy of liability insurance and updated Infection Control plan. LPA Ramirez observe video surveillance in common areas only.

LPA OBSERVATIONS: The facility is a single-story building in a residential area with three (3) resident bedrooms, two (2) shared bathrooms, kitchen, dining room, living room, den/tv room, front yard, backyard and attached garage.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables.

Dining Room/Living room/Den/TV room: Dining room was observed to be clean and contained table and 6 chairs. Living room area has plenty of seating for residents and guests. Den/Tv room was observed to be clean and contained plenty of seating. LPA Ramirez three (3) residents sitting in this area during inspection.

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

Resident Rooms 1 - 3: All resident bedrooms are currently shared. All contained the required furnishings, linens and were observed to be clean.