Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents, with 1 resident on hospice. Administrator (AD) Juan Diaz conducted facility tour. AD provided updated liability insurance that expires on 07/01/2026.

LPA along with AD toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 3 resident bedrooms, 2 staff rooms, living room, dining room, and kitchen as well as 3 bathrooms. At 9:00AM, LPA observed the kitchen counter attached to the sink and drawers being replaced. Then kitchen sink is currently non-operational. The dish washer has been reconnected and moved outside while the kitchen is being repaired. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. 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 at 109.5 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguisher was fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 04/10/2025. Outside grounds were toured. Walkways around the home were clear of hazards. Exit gates are unlocked and operational. There is shaded outdoor seating for residents. Continued on LIC809-C dated 08/07/2025