Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Vanessa Godina Chinchilla, Care giver and explained the purpose of the visit. Shortly after, administrator Lorraine Lopez arrived to assist LPA. The facility is licensed to ser ve age range 60 and over, (6) ambulatory of which (5) may be non ambulatory and (1) may be bedridden. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The required cleaning and disinfection activities are performed. Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control requirements.

Physical Plant & Environment Safety: This facility is a single story home consists of (6) resident bedrooms, (3) bathrooms, (2) living rooms, family room, kitchen, dining area, attached garage and backyard. Resident bedrooms were toured and have sufficient storage space and lighting. Knives, cleaning solutions and disinfectants are locked. The smoke detectors and carbon monoxide detectors are operable. Laundry washing machine and drying machine is in the garage. There are (3) fireplaces adequately screened and covered with a plexiglass, (2) in the living room and one in the family room. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored and locked in the kitchen drawer. Cleaning supplies and chemicals are stored and inaccessible to residents. There are cameras located in the common areas. No security window bars installed. Facility has working telephone service. Water temperature readings are within the required 105 - 120 degrees Fahrenheit. Indoor and outdoor passageways were kept free of any obstruction. Backyard was inspected and has (2) sitting areas with outdoor furniture. There is a swimming pool that is locked and gated with a fence.

Operational Requirements: The Infection Control Plan has been added to the Plan. Liability Insurance

policy in the amount of $1,000,000.00 each occurrence and $3,000,000.00 in the total annual aggregate is

valid, expires on 08/01/2026. There are (2) fire extinguishers that are fully charged, last serviced on 04/17/2026. The outdoor activity area in the backyard provides a shaded area and furnished for outdoor use. *****Refer to LIC 809C for the continuation of this report.*****