Facility Evaluation Report

Licensing Program Analyst (LPA) Villegas conducted an unannounced annual inspection. LPA met with DSP Pretty Tandra as the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents ages 60 and over. Residents are connected with the Harbor Regional Center. Liability insurance is active (Benchmark insurance company Exp: 06/30/27), surety bond is active (66423998 Exp: 10/03/26).

This home is a single story home consisting of: (4) resident bedrooms, (1) staff room (3) Full bathroom,(1) office, living room, kitchen with dining area, laundry room in the attached garage and an outdoor shaded patio area. Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there were sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knives were stored and inaccessible to residents. There are no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 3 staff records, 4 resident records, 4 medication administration records, and 4 P&I ledgers, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 07/05/26, 1 fire extinguishers fully charged, carbon monoxide and smoke detectors are interconnected and operational.

Exit interview conducted, and a copy of this report was provided.