Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Blanca Gonzalez conducted a subsequent annual inspection visit on 04/17/2025 and was greeted by Administrator Diana Medina. LPA Ramirez conducted initial annual inspection on 03/25/2025 and due to time restraints, LPA needed to return another to complete annual inspection. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a main street and has multiple dwellings.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Residents with Special Needs : Large bodies of water were observed and were observed to be fenced and inaccessible to residents. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Emergency pull cords were tested and were observed to be in working order.

Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication room and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services.

Staffing: Administrator Certificate for Diana Medina 10/12/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for five (5) out of the five (5) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for five (5) out of the five (5) personnel record reviewed.