Facility Evaluation Report

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced annual visit to the facility. LPA met with Rosalie Sandoval administrator and explained the reason for the visit. Obtained copy of staff and resident rosters. Toured the facility with med-aid Stephanie Cordova.

The CARE tools were used to conduct the annual investigation for the facility.

The facility is licensed to serve 40 non-ambulatory residents ages 60 and over with an approved hospice waiver for 5 residents. The facility is a 2-story building located in a residential area, it has 20 shared rooms, an activity room, a dining room with kitchenette, a medication room, a cover balcony on the second floor, and a back outdoor area. Facility does not have a kitchen and per the plan of operation they receive food prepared in their sister facility for all resident meals.

LPA Vaid conducted a tour of the facility with Stephanie Cordova and observed the following:

Dining area is clean. Kitchenette's drawers/cabinets were observed, cleaning supplies were observed in a cabinet with a lock and inaccessible to the residents. Activity room was observed. Four (4) resident rooms were observed, room #75, 78, 79 and 86. Each room has sufficient lighting, and required furniture and bedding supplies. A bathroom was observed in each bedroom and water temperature was tested, is within the required 105-120 degrees F. Outdoor area has shaded sitting areas. Last fire inspections were conducted March 2025. Last fire drill was conducted on 04/25/2025, earthquake drills was conducted 04/2025. Two (2) fire extinguishers were observed and last checked on 6/26/2024. A copy of liability insurance was obtained expires 06/04/2026.

Due to shortage of time, the following Care Tools were completed: Infection Control, Operational Requirements, Physical Plant and Environment Safety, Staffing, Residents rights- Information, Planned Activities, Food Service, and Disaster Preparedness.

No deficiencies were noted on today’s visit. Exit interview was conducted with Rosalie Sandoval administrator and a copy of this report, were provided.