Facility Evaluation Report

On May 16, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting a Required-1 year inspection using the CARE Inspection Tool. LPA Bentley was greeted and granted entry by Caregiver (CG) Anna Tangonan and explained the purpose of today's visit. Administrator (AD) Mark Cruz arrived shortly after and was present throughout the inspection. AD Mark Cruz has an Administrator certificate with an expiration date of December 2, 2026.

The facility is licensed for age range 60 and over, approved for capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden, and has a hospice waiver for six (6) residents. There are currently four (4) residents on census and all were present during today’s visit. The facility is a one story house that consists of: five resident bedrooms, one staff bedroom, two bathrooms, 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 family visitation area.

LPA toured the interior and exterior of facility with AD Cruz, and the following was observed: There were no bodies of water on the premises, all rooms were inspected and observed with all required elements, lighting provided, and storage for the residents’ personal belongings. Additional bed linens, comforters, and bath towels were available during the visit. Both bathrooms have secure grab bars and non-slip mats. The water temperatures in both bathrooms were initially measured between 103.6 and 105.9 degrees Fahrenheit. Adjustments were made and when tested a second time, water temperatures measured between 110.6 and 113.5 degrees Fahrenheit. A technical assistance advisory note is being issued and AD agreed to monitor water temperatures to ensure they are maintained at the correct levels.