Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Romeo Casimiro and Evangeline Casimiro, Caregivers and explained the purpose of the visit. At 1:15pm, administrator, Lauri Gallegos arrived and and assisted LPA with the inspection. The facility is approved to serve residents age range 60 and over, (5) non ambulatory, (1) bedridden in bedroom #5, hospice waiver for (6). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. LPA observed that the infection control plan did not show that the administrator/licensee reviewed the procedures in 2025, no date nor signature on the form. Bathroom has hygiene items such as paper towel, hand soap and toilet paper.

Operational Requirements: A fire clearance is in place. Facility has working signal systems in exit points. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 02/01/2027. Fire drill was last conducted on 10/16/2025.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (5) bedrooms, (4) of which are resident bedrooms, (1) staff bedroom, (3) bathrooms, living room with fireplace, kitchen, dining area, breakfast nook, laundry inside one of the bathrooms, attached garage and backyard with patio area. There are currently (6) residents, 60 years and older residing in the facility, (5) are under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. Backyard was inspected. There are (2) fire extinguishers in the facility without proof of purchase provided. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit *****REPORT CONTINUED ON LIC809-C*****