Facility Evaluation Report

On 05/21/2026, Licensing Program Analyst (LPA) Vadim Gorban arrived unannounced for an Annual Required Inspection. LPA met with Administrator Christina Pelayo,( certification number 7020350740 and expiration date of 07/12/2027) stated the purpose of the visit and was allowed entry. A tour of the facility was conducted. Facility has one entrance/exit point.

The facility appeared clean with no obstruction or fire clearance issues. Fire extinguisher service date on November 22th, 2025. Last fire drill recorded on 5/01/2025

Hand sanitizer was readily available to residents and visitors. Bathrooms have trash cans with lid. All three resident bedrooms were checked. Also, exterior tour was conducted.

Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Refrigerator temperature was maintained at 39.0-degree F. and freezer was maintained at -0-degree F. Food supply was checked and there appeared to be an adequate supply.

LPA checked residents’ medication records, medications stored in locked cabinet. Cleaning supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed communicating with resident in polite manner. LPA observed residents after lunch in common area.

LPA reviewed staff, resident’s files and facility for required records.

Facility operational phone number 209-664-1378. Deficiency recoded on LIC809-D

Exit interview was conducted, report signed and with appeal rights provided to administrator for facility records.