Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

The facility is licensed for 6 residents, 5 of which can be non-ambulatory and 1 can be bedridden. The facility has a hospice waiver for 2 residents.

This is a single story home with an attached garage. The facility has 5 bedrooms and 3.5 bathrooms.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in the bathrooms. The hot water temperature measured 99.8 and 102.5 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill on 4/10/2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed secured medication storage in kitchen. LPA observed emergency food was stored in laundry room which is attached to the kitchen.

LPA reviewed one out of one staff training and fingerprint records and conducted a complete review of 5 out of 5 residents files. Administrator has a current administrator certificate which expires on 11/30/2025.

Based on observations the following is being cited per Title 22. An exit interview was conducted and a copy of appeals rights and this report were provided to facility.