Facility Evaluation Report

On 1/16/25, at 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Gamer Jim Nazari.

An application was submitted to Community Care Licensing Division-CCLD on 06/20/2024, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The pending facility will have a Dementia Care Program. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents, and Hospice waiver for six (6) residents. Fire clearance was approved on 11/14/2024.

Structure: The facility is a single-story building with five (5) bedrooms and two (2) bathrooms. One (1) room will be designated staff room only.

Entrance: There is only one (1) entrance being utilized. Required postings such as: Personal Rights of Residents, Rights of Resident by Council, Family Council, Infection Control, Emergency and Disaster Plan, Facility Sketch, Theft and Loss Policy, House Rules, Non-discrimination Policy and See Something Say Something are posted upon entry.

Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. The dining area is also neat, clean, and organized. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy (70) degrees. No firearms observed or will be maintained on the premises. There is a working telephone on the premises.

Fireplace: LPA observed fireplace covered and inaccessible to residents.

Resident/staff files: Resident and staff files will be kept in the office located near the garage. Files will be kept in a locked cabinet inaccessible to Residents. First-aid kit observed as well.