Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Annual Required 1-year Visit on 04/01/2025. LPA was met by Staff Karla Pablo Damian and explained the purpose of the visit. Administrator Amanda Palomino arrived later to assist with the visit. Vannesa Hinojosa was also present and assisted with the visit. The facility is licensed to serve six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for four (4). Two (2) out of the six (6) residents in care are currently on hospice care.

LPA OBSERVATIONS: The facility is a single-story dwelling located on in a residential neighborhood and consists of three (3) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, detached garage, front yard, and backyard. LPA Lopez observed auditory device on entry of door to be operational, sliding door and exits.

Front Yard: Is well maintained and no hazards were observed during visit.

Kitchen: LPA Lopez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Lopez observed knives and sharps located in kitchen cabinet, to be inaccessible to residents in care. LPA observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. Kitchen appliances were observed to be clean and in working order. LPA observed staff preparing lunch for residents during visit. Monitor was observed to be mounted near sink area and accessible to residents, staff, and visitors. LPA Ramirez has addressed this issue on previous visit. .

Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. LPA Lopez observed five (5) out of the six (6) residents seated in this area during the visit. ( See 809-C for continuation).