Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility to conduct an Annual Required inspection. LPA was greeted and granted entry by staff and explained the reason for the visit.

The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which six may be on hospice. The facility currently has a census of six residents with two residents on hospice.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature. The hot water temperature measured between 110 and 116.7 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on March 4th 2026. 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 drawer. LPA observed unsecured medications in kitchen cabinet to the right of the sink in a Kaiser paperbag. LPA observed four Bic lighters in the drawer on the right of the stove. LPA observed middle burner of the 5 burner stove is non operational.

LPA reviewed two out of two staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on November 18th 2026.

Based on observations made deficiencies are being cited per Title 22. An exit interview was conducted and a copy of this report and appeal rights were provided.