Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan conducted an Annual Required visit and inspection of the facility. LPA met with the administrator Jessica Pelaya and explained the reason for the visit.

At approximately 09:43 AM, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. Currently there are eighteen (18) residents receiving hospice care and sixty eight (68) residents on the Assisted Living Waiver (ALW). The smoke alarms and carbon monoxide detectors are dual, hardwired and interconnected. The smoke detectors were last serviced on 09/12/24. Facility also have a functional sprinkler system. There are fire extinguishers located throughout the facility hallways. Fire extinguishers were last inspected on 11/30/23. The Fire Inspection was last held on 09/17/24.

Kitchen: The kitchen has an industrial setting and observed to be clean and in proper order. Appliances and fixtures were observed to be functional. Sufficient amount of perishable and non-perishable food were in stock and properly stored. Kitchen is inaccessible to residents. Dishwashing liquids and other cleaning agents are separated from food preparation area.

Bedrooms: The facility has two (2) floors. The first floor has fifty-two (52) shared bedrooms and the second floor has sixty-four (64) shared bedrooms. Random rooms were inspected and LPAs observed appropriate beddings and linens with sufficient lighting.

Bathrooms: Each resident unit on both floors have their own bathrooms. Both bathrooms were properly supplied and had functional fixtures including grab bars. Hot water temperature was measured at a range of 105.4°F to 109.4°F. (continued on LIC 809-C)