Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Caregiver 1. Administrator (AD) Mark Cruz arrived shortly after and discussed purpose of the visit. AD Mark Cruz has an Administrator certificate with expiration date of 12/2/2024.

The facility is a two-story house of which second story consists of: 4 bedrooms, and 3 bathrooms which is utilized for caregivers and Administrator headquarters. The first floor consists of: 4 resident bedrooms; of which 2 bedrooms are shared bedrooms and 2 are private bedrooms, 3 bathrooms for staff and residents, living room, dining area, and kitchen. There is a sun-room in the back of the facility next to dining area used as an activity room and for family visitations.

There is an attached 2 car garage with an operational washer and dryer. The backyard has a shaded concrete area for resident and visitor enjoyment. The exit gates on the exterior of the home are locked from the outside have self-closing and self-latching mechanisms in operating condition.

The facility is licensed for age range 60 and over, approved for capacity of 6 (six) Non-Ambulatory residents, and has a hospice waiver for (6) six residents. There are currently (4) four residents currently receiving hospice care services.

LPA along with CG1 toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed Sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care.