Facility Evaluation Report

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

The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which six may be on hospice. The facility currently has a census of six residents with three residents on hospice.

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 two bathrooms. The hot water temperature measured between 114 and 115.8 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on March 01, 2026. 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 completed medication appear to be being given as prescribed.

LPA reviewed two out of two staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on July 21, 2026

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