Facility Evaluation Report

On this day Licensing Program Analysts (LPAs) Fred Arias and Nancy Guillen made an unannounced visit to conduct a required annual visit. LPAs were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 14 residents of which 11 may be non-ambulatory and bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 12 residents. Assistant Administrator (AAD) Franco Puzon assisted with facility tour. AAD provided updated liability insurance that expires on 7/13/2026.

LPAs along with AAD toured the facility at 9AM. LPAs toured the physical plant, checked food service, and facility documentation. The facility is a two story building and consists of 8 resident bedrooms, living room, dining room, 3 staff rooms, staff kitchen, and resident kitchen as well as 3 resident bathrooms. At 9:05AM, LPAs observed a small refrigerator with resident medications that is unlocked and accessible to residents. At 9:07AM LPAs observed one of the exit doors in resident room 8 locked, preventing the resident from leaving through that door. At 9:17AM, LPAs observed a padlock placed on the exit door for room 1, preventing residents from leaving through that door. At 9:45AM, LPAs observed a resident bed in room 6 that was partially blocking access to the exit door, making it inaccessible to residents. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.6 degrees F and 119.1 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPAs toured the kitchen and observed sharps locked in a cabinet during today's visit.