Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with caregiver Elizabeth Rodriguez and explained reason for visit. Administrator Elba Rodriguez was notified by telephone and stated she was attending a personal matter.

Facility is licensed to serve six (6) non-ambulatory residents age 60 and over. The facility may retain three (3) hospice residents. The facility is in a residential area. A tour of the facility included the living room, kitchen with dining area, 4 resident bedrooms, 2 bathrooms, attached garage, and outside shaded area for residents.

LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. LPA observed one resident with full bed rails and no hospice plan available. Room #2 had a mattress and bed rails on floor. The Smoke /carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has three (3) fire extinguishers that were serviced on 07/21/2026. Cleaning supplies and toxic substances were observed to be accessible under kitchen sink at time of visit. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents outside. Passageways and exits are free of obstruction.

LPA was unable to review Administrator, staff/staff training, and resident files due to staff having no access to documents and Administrator being away and not having an authorized designee. Facility did not have dementia plan of operation available at time of visit along with required Liability Insurance. LPA requested a copy of infection control plan, emergency disaster plan, and emergency drills conducted at facility. LPA could not conduct a medication check due to staff not having a list of prescribed medication from physician with dosages at time of visit.

Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Elizabeth Rodriguez.