Facility Evaluation Report

On 04/17/2025 at 11:00am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Alvin Banzuela, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which two (2) may be bedridden and a waiver granted for an approved hospice care for six (6) residents. Three (3) of the residents are diagnosed with dementia, zero (0) residents receive home health, and three (3) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money.

The facility fees are a balance of $495 due on 06.24.2025. LPA provided pin #386307 with the option for the facility to make an payment online. The facility has liability insurance with Perlas Insurance with an effective e date as 10/28/2024.

The home is a single home consisting of : (4) resident bedrooms, (2) full bathrooms, living room, kitchen with dining area, a attached garage and an outdoor shaded patio are in the backyard.

Between the hours 11 :06am - 11 :28am, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured at 106.5 F (in the kitchen), 118.2F (in bathroom #1) and 118.0F (bathroom #2). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions.