Facility Evaluation Report

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced one (1) year inspection at this facility. LPA met with Administrators and explained the reason for the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

At 11:00 AM. LPA and Administrator conducted a physical plant tour of the facility. The facility has one main entrance being used. Required posting are observed to be complete, current and displayed properly. The facility has an approved mitigation and infection control plan on file.

The facility is a two story home in a residential community. It consists of five (5) bedrooms and two (2) bathrooms, kitchen, laundry room, covered patio and detached ADU. Two (2) bedrooms are double occupancy and two (2) bedrooms are single occupancy designated for residents, and one (1) bedroom on the second floor is designated for staff use. The facility is licensed to serve (6) residents ages 60 and above of which (6) may be bedridden. Facility has an approved hospice waiver for (6) residents.

Smoke detectors and carbon monoxide were tested for proper function. Fire extinguishers were last serviced on 05/22/2025 and observed fully charged. The most recent disaster drill was conducted on 01/08/2025. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors were inspected. They were found clean and good repair. The facility maintains a comfortable temperature at 71°F.

Living Room furniture was checked. Furniture in the living rooms was observed in good repair, clean and free of hazards. It was appropriately furnished and provided a comfortable environment for residents. Resident bedrooms are adequately furnished with appropriate furniture and lighting system.