Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit. LPA was met by Richel Feria, the Caregiver and explained the purpose of the visit. The Administrator, Cherie Wood arrived shortly after and the LPA explained the purpose of the visit. Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents. There are (1) bedridden and (1) hospice residents.

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

Infection Control: Facility has an updated infection control plan dated 11/01/2024 in place. The facility staff and residents continue to practice hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies.

Operational Requirements: Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents which is within the fire clearance requirement. LPA observed current Liability insurance in place. The facility has a dementia care plan to accept or retain residents with dementia. The fire drill was last conducted on 06/17/2025.

Physical Plant/Environment Safety: A tour of the single-story facility included: four (4) resident bedrooms, one (1) staff bedroom, one (1) resident bathroom, living room, kitchen, laundry room, front yard, backyard, and attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The front and backyard are well maintained.