Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA met with Vanessa Arbis, Caregiver and Tito Riobuya, Caregiver and explained the purpose of the visit. At 1:50pm, Rebecca Sinclair, Co-Administrator arrived and assisted LPA with the inspection. The facility is licensed to serve six (6) non-ambulatory residents ages 60 years of age or older. The facility may retain a maximum of (6) hospice residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following:

Infection Control: Staff are adhering to infection control requirements. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility.

Physical Plant/Environment Safety: The facility is a single-story home which consists of: living room with covered fireplace, dining area, kitchen, (3) bedrooms (3 residents and 1 staff), 3 bathrooms, laundry area, back yard, front yard and detached garage where part of it is used as caregivers bedroom. Resident bedrooms were inspected. The bathrooms are clean and operational. The hot water temperature was tested throughout the facility. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. At approx. 1:30pm, readings were 140 deg F in bathroom #2 and 133.8 deg F in bathroom #2. At 2:30pm, LPA re-checked the hot water temperature and readings were 135.3 deg F in bathroom #2 and 130.7 deg F in bathroom #3. LPA observed sufficient food supply of (2) days of perishables and (7 days) of non-perishables. Knives, disinfectants, and cleaning solutions are kept locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguisher is fully charged and last serviced on 05/13/2025. The first-aid kit is fully stocked w/first-aid manual. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. A shaded area with outdoor furniture is provided in the back yard. The backyard is free of debris/hazards. There is no evidence of bodies of water (pool) or security bars nor weapons on the premises. LPA observed part of the garage is being used as a sleeping room for staff.

Operational Requirements: The facility accepts and retains residents with dementia. The plan of operation includes training for staff who provide dementia special care. Facility maintains liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate which expires on 06/16/2026 . According to the co-administrator, the facility does not handle cash resources for the residents.