Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced required annual inspection of this facility and met with Licensee/Administrator Elvira Gazal. Facility has 3 residents receiving hospice care and residents with dementia diagnosis. Required postings observed. Annual fees are current.

LPA/Administrator toured the facility common areas, residents rooms, kitchen and bathrooms observed had sufficient lighting. Residents rooms are furnished per regulation. The facility was a comfortable temperature. Passageways were free of obstructions. Facility has a sufficient supply of cleaners and hygiene items. Facility has fire pull station. Some residents have a call button that alerts staff in the kitchen. The kitchen area were found to be clean and sanitary; There was sufficient supply of perishable and non-perishable food. Prepared and left over foods were covered and labeled. The facility has emergency supplies to meet requirements of the 72-hour shelter in place. All medications were all locked and inaccessible to residents. Facility's smoke and carbon monoxide detectors were operational. Bathrooms have non-skid surfaces and grab bars at the toilet and shower areas. Exit doors have auditory alarms to alert staff. The last fire drill was conducted 2/1/26. Medication is centrally stored and secure in kitchen. Facility has a generator.

- At 10:00 AM, LPA conducted a file review of three staff and six residents. All staff have current 1st aid or CPR certificates and required annual training hours completed There are residents receiving hospice care services within the approved hospice waiver. All residents' care plans are updated. Medical assessments are current and included a description of any known behavioral expression. Elvira Gazal, Administrator Certificate 7002386740 expires 1/12/2028.

Licensee agrees to submit updates of the following documents by not later than 4/7/26: LIC500 Personnel Report and Copy of liability Insurance.

No deficiencies cited during today's visit. Exit interview conducted with Administrator and copy of this report was given.