Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required inspection of the facility. LPA was welcomed by designee/staff Gladys Flores. Elizabeth Allen Licensee/Administrator was contacted by staff although unable to attend today’s inspection, authorized designee to sign for today’s visit. Facility is single story with 5 bedrooms that Novato Fire has granted clearance for 6 Non ambulatory residents. Facility has hospice waiver for 2. There is a total of 4 residents, 2 with a major neurocognitive disorder diagnosis and none on Hospice.

LPA toured the facility on 9/2/2025 at 8:45 AM with designee/staff Gladys Flores; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices which were working properly at the time of the visit. Fire Extinguisher was found to be last charged on 9/24/2024. Smoke detectors and carbon monoxide were found to be operational during the visit. Hot water temperature measured 106.3 to 116.6 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 out of 2 resident’s bathrooms while touring facility on 9/2/2025 at 8:45am. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry/garage room; although bleach was observed under resident bathroom sink without lock (see pics & LIC809D).There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations.