Facility Evaluation Report

On 1/07/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. Upon arrival LPA rang the doorbell which Administrator Emalyn Anguiano responded through the video “Ring” doorbell. LPA stated the reason for their visit. The Administrator stated she is not available for today’s visit, and they have zero (0) residents currently. The Facility Representative Kim Vivar arrived shortly after to assist with today’s visit.

LPA asked for census and insurance. LPA conducted a physical plant tour at approximately 11:15 AM and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying zero (0) residents. One (1) staff room located in approved conversion of garage. The facility has approved fire clearance for six (6) residents of which four (4) may be ambulatory and two (2) non-ambulatory. Hospice waiver approved for six (6).

Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Required postings such as See/Say Something, Long-Term Ombudsman, and Resident’s Rights were located upon entrance.

Common areas: Living room and dining room observed to be neat, clean, and organized. Common areas observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. Fire extinguishe r located in the kitchen and dated 03/04/24.

Kitchen: Kitchen observed to be clean and inaccessible to pests. Knives and sharps observed to be locked in kitchen drawer inaccessible to residents. Cleaning solutions and toxins observed locked underneath kitchen sink (continued on LIC 809-C)