Facility Evaluation Report

Licensing Program Analysts (LPA) Christian Gutierrez conducted an unannounced annual visit at the facility using the CARE Tool. LPA Gutierrez met with Elvira David (Administrator) and explained the reason for the visit.

The facility is licensed to serve 6 residents over the age of 60, four (4) non-ambulatory and approved for two hospice waivers. The facility is operating within the scope of its license. The facility is a two-story home located in a residential neighborhood, consisting of (5) five bedrooms and (4) bathrooms. The first floor consists of (3) client bedrooms and (3) client bathrooms, a living room, kitchen and a community/activity room with a staff room. Upstairs is for staff use only, of which residents do not have access to, and it consists of (2) bedrooms and (1) one bathroom, backyard, and attached garageLPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. The Smoke and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has two (2) fully charged fire extinguishers which are kept in kitchen, and living room. Cleaning supplies and toxic substances were observed to be inaccessible to residents in care. 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 residents’ bathrooms have the required grab bars and non-slip mats for residents. Clean towels and extra clean linen were observed in bedroom cabinet. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents in backyard Passageways and exits are free of obstruction. There is extra food and supplies in garage.

Four (4) staff files were reviewed and included criminal clearance record, and health screening with TB. Four (4) resident files were reviewed and included physician’s reports and appraisal needs and service plan. Fire/earthquake drill was conducted July 5 th ,2026. The medications are centrally stored and locked in a cabinet closet in dining room. LPA reviewed medication for all 4 of the residents and observed that medications are documented properly and given as prescribed.

No deficiency was observed during today’s visit. Exit interview was conducted with Elvira David and a copy of report was provided.