Facility Evaluation Report

On 10/31/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced required – annual inspection and was met by staff one, Salvacion Medina - Administrator (S1).

The facility is licensed to serve six (6) ambulatory residents, of which four (4) may be non-ambulatory and one (1) may be bedridden. Bedroom #1 is approved for ambulatory. Bedroom #2 and #4 are approved for non-ambulatory. Bedroom #3 is approved for bedridden and non-ambulatory. The facility has a hospice waiver approved for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of (4) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and a attached garage.

Staff one (S1) accompanied LPA inside and outside the facility during today's inspection.

Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked during today's visit. All water sources presented water temperature within title 22 regulation

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. Staff tested the carbon monoxide detector and smoke detectors in the house. All devices were functional.

Five (5) resident records and two (2) staff records were reviewed. No discrepancies were observed.

There have been zero deficiencies cited during today's visit. An exit interview was held with S1 and a copy of this report have been provided.