Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by Administrator David Molina. David Molina's Administrator's Certificate expires on September 9, 2026. The facility is a single story home with 7 bedrooms (1 bedroom is for staff), 6 bathrooms, living room with a fireplace, kitchen, dining room and a family room with a fireplace. Facility is licensed for 6 non-ambulatory residents with a hospice waiver for 3. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the living room. The PUB 475 poster is visible from the front door. . The last fire drill was conducted on March 12, 2026. LPA observed the kitchen is clean and organized. LPA observed the kitchen stove has the knobs removed for safety. There is a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the stove lights unassisted. Knives are kept locked in a kitchen drawer. Cleaning supplies and chemicals are kept locked under the kitchen sink. LPA observed all 6 resident rooms had the required furnishings. LPA observed all 6 resident bedrooms are clean and organized. Hot water measured 106.7 degrees Fahrenheit in the shared bathroom in the hallway next to the living room. Smoke detectors/carbon monoxide detectors tested operational. LPA inspected the first aid kit. The first aid kit had all the required elements. LPA observed extra linens and blankets stored in the pantry in the hallway. LPA observed a 3 day emergency food and water supply stored in the hall pantry. LPA and Administrator toured the backyard. LPA observed a raised fountain in the backyard. There is a covered seating area with a table and chairs. Both exit gates on each side of the house are latched and self closing. No obstacles or hazards observed in the backyard. LPA reviewed all 5 resident medications. No discrepancies observed. LPA reviewed 5 resident files, no discrepancies observed. LPA reviewed 4 staff files, no discrepancies observed. All 4 staff had the required training and CPR/First Aid training. All 4 staff had the required training and CPR/First Aid training. No obstacles or hazards observed inside or outside of the facility.