Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year Visit on

02/15/2024. LPA was met by Administrators Nino Navarro and Michelle Navarro and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which four (4) may be non-ambulatory and has a hospice waiver approved for five (5). Bedroom #1 is approved for one (1) bedridden resident. Bedrooms# 3,5,6 is approved for non-ambulatory. Bedroom#4 is approved for ambulatory only.

LPA OBSERVATIONS: The facility is a two-story dwelling located on a residential street and consists of five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits.

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

Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 106.5 degrees F. Kitchen appliances were observed to be clean and in working order.