Facility Evaluation Report

At approximately 2:00PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Lead Staff Member, Shella Pastor . Administrator, Libia Cruz Leon , arrived during visit at approximately 2:15PM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Facility has a hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 4 residents in care, with 1 resident out of the community attending Day Program. LPA was also informed that there were 3 staff members on site.

At approximately 2:10PM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Lead Staff Member and Administrator. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected May 2025. Per Administrator and Lead Staff Member, Fire Department is coming this week to renew the fire extinguishers. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted February 2026. Facility's emergency and disaster plan was last reviewed and updated 02/26/2026.

LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.