Facility Evaluation Report

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today January 30, 2026 for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Shamonique Anderson.

Facility is licensed for 4 residents and has a current census of 2. Water temperature was checked in the kitchen which read at 109.5 degrees Fahrenheit and the common bathroom which read at 107.2 degrees Fahrenheit. Fire Extinguisher was purchased January 30, 2026 and has current charge. LPA observed smoke and carbon monoxide detectors which are showing green, and administrator stated they are tested monthly (resident is currently sleeping).

Shamonique Anderson’s Administrator Certificate expires on 8/18/2027. Resident and staff files were reviewed. R1 is missing physician's report and R2 does not have PRN physician blank. Facility provided verification of disaster drills that are conducted quarterly. First aid kit on site and complete. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Deficiencies observed during today's inspection are cited per California Code of Regulations, Title 22.

Exit interview conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Administrator Shamonique Anderson.