Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility today to conduct an Annual Required inspection. LPA was greeted and granted entry and explained the reason for the visit.

The facility is a single story building with an approved fire clearance of six non-ambulatory clients. The facility currently has a census of six clients in care.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors. LPA observed all smoke detectors were operational. The facility’s last fire drill was conducted on April 07 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.

LPA reviewed five out of five staff training and fingerprint records. LPA conducted a complete review of client

records. LPA confirmed that administrator has a current administrator certificate which expires on November 4th, 2025.

Based on the observations made during today’s visit no deficiencies cited on this date . An exit interview was conducted with Theodora Fredericksen, Administrator and a copy of this report was provided.