Facility Evaluation Report

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff. Administrator Belen Taico was explained the purpose of the visit telephonically.

The following was observed during the inspection:

Infection Control: The facility has an Infection Control Plan that is reviewed annually.

Operational Requirements: A Dementia and hospice waiver for 4 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate expires 8/26/2026.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is located in a residential neighborhood that consists of 4 resident rooms, 2 bathrooms, dining room/ living room, office, laundry room, medication/storage room, outdoor patio area, and detached garage. Smoke and carbon monoxide detectors were tested and are operational. The facility has three (3) fire extinguishers. Rooms are equipped with required furniture and bedding. Cleaning supplies and toxic substances are inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Electrical smoke and carbon monoxide detectors were tested and are operational. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted on 6/18/2026.

* R1 & R2's bed had full length bed rails but residents are not enrolled in hospice. Room #4 has an oxygen tank, but required No Smoking posting was not observed.