Facility Evaluation Report

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

The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for two (2) residents. Currently, there are six residents present during visit and zero residents on hospice. Facility is a two story with a two-car garage home. The facility has four bedrooms (two private resident rooms & two shared rooms), one office and four bathrooms.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in four out of four bathrooms. The hot water temperature measured 118.6 and 120 degrees Fahrenheit and smoke detectors in residents rooms were non-operational. 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 and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA observed emergency food and water in the garage. LPA did not observe emergency drill documentation. LPA did not observe staff training records.

LPA reviewed 3 staff fingerprint records and conducted a complete review of six out of six resident records. LPA confirmed that administrator has a current administrator certificate which expires on August 18th 2026.

Based on observations made during today's visit the following is being cited per California Code of Regulations. A copy of this report and appeal rights were provided.