Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual inspection visit using the CARE tool. LPA met with Fe Abejo Caregiver and explained the reason for the visit.

The facility is licensed to serve (6) elderly residents age 60 and above of which all may be non-ambulatory, and a hospice waiver for (3). The facility is located in a residential area and consist of a single home with a kitchen, dining room, living room, (3) resident bedrooms, (2) bathrooms, an office space, staff room,laundry/storage space, and a backyard.

The following domains were reviewed during this visit:

Infection Control : Facility maintains a copy of infection control and was last reviewed on 7/1/25. All staff have a TB clearance.

Operational Requirements: Facility maintains a plan of operation, infection control plan, fire clearance. Facility is operating within the limitations of their license. They currently don't have residents under hospice care. A current liability insurance was observed and a copy was obtained.

Physical Plant/Environmental Safety: LPA toured the facility with Fe Abejo caregiver and observed the following. Facility was observed in good repair. Living room has a fireplace with a metal cover and it is furnished. Dining room was observed with furniture and in good repair. Kitchen was observed clean, a large pair of scissors was observed in a small drawer without a lock which was moved by staff to a drawer with a lock which was unlock at the time of the visit were knives and sharps are stored. Refrigerator/freezer and pantry were observed. Medication cabinet is located in the kitchen area. Passage ways were observed clear of obstructions. Back porch and side porch were observed with old furniture clutter around, A ripped chair cushion chair was also observed. Garage space has been converted into an office space, a staff room, and laundry/storage area. (CONT. 809C)