Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Janet Oliveros, direct support staff for the facility, and explained the purpose of the visit. Owner Ruby Cruz arrived shortly thereafter. There are five (5) residents currently living in the facility.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

· The facility is a single-story home located in a residential neighborhood. The facility consists of a kitchen that contains the washer and dryer, an attached garage the contains extra supplies for the facility, a dining room, a living room, three (3) resident bedrooms, one (1) staff room, two bathrooms which both measured between 105 - 120 Degrees Fahrenheit, and a backyard with shaded area. The facility was observed to be in good repair.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility.