Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Nancy Villanueva and explained the reason for the visit. Supervisor John Bardon arrived approximately 10:25am to assist with the inspection. Administrator Brian Schott holds a valid certificate expiring on July 3, 2026.

The facility is a single story structure and is licensed to provide services for age range 60 and over for six ambulatory residents of which six may be non-ambulatory. A waiver was granted to provide hospice services to six residents at one time. During today's visit, there are three residents under hospice care and three staff on duty.

LPA toured the physical plant with Caregiver Villanueva. During the inspection, LPA observed the following areas requiring a deep cleaning and repair: the interior and exterior kitchen cabinets and appliances had evidence of grime and oil residue that require a deep cleaning, pantry needs to be reorganized, cleaned, and relined with a shelf liner, and the fire alarm pull station panel was half detached that needs to be reattached. LPA observed five resident bedrooms and three resident bathrooms. There is one additional staff bedroom occupied by four live in staff. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 117.5, 115.7, and 113.7 degrees Fahrenheit. All common areas were inspected including the two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage.