Facility Evaluation Report

***This is an amended Annual Report originally completed on 01/21/2026 under an incorrect facility. Licensing Program Analyst (LPA) conducted a case management visit on 01/28/2026 to create and deliver the annual report reflecting this facility.***

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Christian Reyes; Caregiver explained the reason for the visit. Deborah Davis, Administrator/Licensee, arrived shortly thereafter.

This home is licensed to serve 6 residents ages 60 and over, six (6) non-ambulatory of which two (2) may be bedridden. Facility has a hospice waiver for six (6) residents.

There were two (2) residents under hospice care during inspection.

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. “No smoking - Oxygen in Use signs” in various locations of the facility.

The facility is located in a residential neighborhood and consists of a single-story home. The home includes five (5) resident bedrooms, one (1) caregiver bedroom, and three (3) bathrooms, of which one (1) is a private bathroom and one (1) is designated for visitor use. The facility contains a large, combined living room and dining room area, an additional living room, kitchen, dining area, attached garage, front yard, and a large backyard. (continued on 809C)