Facility Evaluation Report

On 4/28/25 at 1 PM, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by Adminstrator (AD) Dennis DeLa Cruz after explaining the purpose for today's visit. LPA observed that Administrator Dennis DeLa Cruz has a valid Administrator certificate which expires January 18, 2026.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents on the first floor, and has a hospice waiver for four. The facility is a two story home with three shared resident bedrooms on the first floor, two shared resident bathrooms on the first floor, a living room, a dining room, a kitchen, two staff bedrooms upstairs, one staff bathroom upstairs, and an attached two car garage. LPA, accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, one of which is on hospice, and three staff present. LPA observed residents relaxing in their respective bedrooms and in common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the three shared resident bedrooms and they were observed to be free of hazards. LPA observed resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two residents bathrooms and they were observed to be clear of hazards. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 113.5 and 114 degrees Fahrenheit. LPA observed the second story of the facility is for staff use only and is off limits to residents in care.