Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to Belmont Village. The purpose of today’s visit was to conduct the required 1 year inspection. LPAs were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 180 non-ambulatory residents of which 35 may be bedridden. Facility has an approved hospice waiver for 35 residents. There are 10 residents on hospice during today's visit. The facility has 147 apartments with 46 units for memory care. Administrator Rosa Ayala has an administrator certificate expiring on 10/23/2026. Upon entry, facility appears clean, safe and sanitary.

LPAs Lyman and Mendivil along with Building Engineer John Lachey toured the facility at 9:40 AM. LPAs toured the physical plant, checked food service, reviewed files as well as reviewed medication administration. LPAs toured the memory care unit as well as assisted living. The main kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen and temperatures were in compliance. LPAs observed menus in the main dining room. Residents order off a menu and facility has daily specials for variety. There is an auxiliary kitchen and dining room in the memory care unit as well as a bistro in the assisted living. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPAs pulled emergency cords and staff response was immediate. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Ten resident bathrooms were tested for water temperature and water temperature measured between 113 and 118.4 degrees F in tested bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Smoke/carbon monoxide detectors are hardwired and facility has sprinklers. CONTINUED ON LIC 809C DATED 02/19/2026