Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giving staff. Administrator (AD) Alexander Arias was notified via telephone and arrived shortly after in order to assist with the annual inspection. LPA began a tour of the facility and observed the following. AD has a valid Administrator Certificate valid from April 20, 2026 through April 19, 2028.

The facility is a one storied home equipped with four bedrooms, two bathrooms, and a one car detached garage. LPA observed kitchen area to be clean and free of any mildew or debris. LPA observed the kitchen area to have a refrigerator, microwave, and a gas stove. All appliances appeared to be in good repair and tested operational. LPA observed a two day supply of perishable food and a seven day supply of non-perishable food, and a sufficient amount of emergency water.

LPA observed all resident rooms to be free of any hazards, and any obstructions along the entrance ways. LPA observed all resident rooms to be large enough to walk about freely, and to have all required furnishings including: A bed, clean linens in good repair; meaning no strains or tears, a chest of drawers, a reading lamp, a chair, and enough storage space to store personal belongings.

LPA observed all restrooms to be clean and free of any mildew and debris. LPA observed all water faucets, and toilets to be operational. LPA observed bathrooms to have all required furnishings including: Grab bars, slip resistant floor matts, and a shower chair as needed. Hot water temperature tested between 109.2 and 111.3 degrees Fahrenheit. CONTINUED ON LIC809-C