Facility Evaluation Report

On 12/1/2023 at 9:30 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual inspection visit to the above facility. LPA met with Caregivers Iosefo Naumati and Imelda Diquit and LPA explained the purpose of the visit. Administrator/Licensee Coty Cabral arrived later and joined the visit.

Facility is licensed to serve residents age range 60 and over, six non- ambulatory residents of which, one may be bedridden and approved hospice waiver for two residents. During this visit, there is one hospice resident.

This is a single-story home consisting of four resident bedrooms, one staff bedroom, one common bathroom, one ensuite bathroom (bedroom#5), living room, kitchen with dining area, garage, and a shaded outdoor patio.

At 9:42 AM, LPA Montoya toured the facility with Caregiver Imelda Diquit. The kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents.

At 10:30 am, outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.