Facility Evaluation Report

On September 2, 2025, Licensing Program Analysts (LPAs) Brandon Lopez and Garlli Tat made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrators (ADs) Rosa Reyes and Johan Mathews were notified via telephone and later arrived to assist with the inspection. LPAs observed that Rosa Reyes has a valid Administrator certificate which expires on April 11, 2026.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for six. The facility is a single story home with five resident bedrooms, one of which is shared, one staff room, five resident bathrooms, a living room, a dining room, a kitchen, a family room, a laundry room, and an attached two car garage. LPAs accompanied by the ADs conducted a tour of the interior portion of the facility. On today's visit, LPAs observed six residents in care and two care giving staff present. LPAs observed the See Something, Say Something poster (PUB 475) mounted on the wall by the kitchen. LPAs inspected the five resident bedrooms, and they were observed to be free of any hazards. LPAs observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPAs observed additional linens are stored in the laundry room. LPAs inspected the five resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 109.4 and 110.4 degrees Fahrenheit. LPAs observed the staff bedroom can be kept locked.

LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives are stored in a locked kitchen cabinet. CONTINUED ON LIC809-C