Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit. LPA met with Ian Baker, the Administrator and explained the purpose of the visit. Facility is licensed to serve elderly residents age 60 and above, fire clearance approved for (72) non-ambulatory. Hospice approved for ten (10) residents.

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

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has an Infection Control Plan. Staff are adhering to infection control requirements. Emergency and disaster plan was completed and up to date. Infection control practices and Personal Protective Equipment (PPEs) were maintained.

Operational Requirements: The Infection Control Plan has been added to the Plan. Facility is approved for (10) hospice residents, 87705 compliant. A fire clearance is in place. Fire Drill was last conducted on 1/15/2026. A Valid Liability Insurance and Valid Surety bond are in place.

Physical Plant/Environment Safety: The facility is a two-story building located in a residential community. The facility consists of: First floor: Lobby, Administrative offices, Conference room, Supply room, Power/Telephone room, Kitchen, Janitor room and Elevator. Second floor: (35) resident bedrooms, Medication room, Library, Activities room, five (5) shower rooms, staff room, Beauty shop, Doctor's office/Nurse station and Dining room.