Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility today to conduct a required annual. LPA was greeted and granted entry by staff and explained the reason for the visit.

Facility is licensed for 6 non-ambulatory residents of which one can be bedridden. Facility has an approved hospice waiver for 4 residents and the home currently has 4 residents.

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 in bathrooms. The hot water temperature measured between 106.2 and 109.8 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on December 1st 2025. 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 medication storage in locked kitchen cabinet. LPA observed emergency food in facility pantry and emergency water in staff bedroom.

LPA reviewed three of three staff training and fingerprint records. Staff 1-3 (S1-S3) did not have the required training hours .LPA conducted a complete review of resident records. LPA observed Resident 3 (R3) to have half rails without a physician's order. LPA confirmed that administrator has a current administrator certificate which expires on 04/27/2026.

Based on the observations made during today’s visit deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.