Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the visit, LPA toured the facility and observed the following: There are three residents and one staff present during today's visit. LPA observed the food supply. Facility has bare minimum of two day perishables and seven day non-perishables. LPA observed food in an auxiliary freezer. Staff stated food gets delivered one time per week. LPA observed an ample emergency food and water supply. Utilities are all in working order as well as kitchen appliances. Sharps and medications are secured. Resident rooms are clear of clutter and lights/ TV's are operational. Restrooms are in order and appear clean and sanitary. LPA observed ample hygiene supply as well as linens. Fire extinguishers are fully charged. Smoke detector/ carbon monoxide detectors are operational during today's visit. No obstacles or hazards observed in the backyard. All staff on LIC 500 are cleared and associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA removed files for Residents #1-3 for copy and will return the files by close of business today, February 3, 2026.

Based on the observations made during today’s visit, NO deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Exit interview conducted and a copy of this report was left at the facility.