Facility Evaluation Report

On November 21, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Maria Jimenez about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. AD later arrived to assist with the inspection.

The PUB475 ‘See Something, Say Something’ poster was observed to be located in the dining room. LPA observed the Administrator's Certificate for Maria Jimenez, which expires on April 20, 2027.

The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and hospice waiver for two. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of six non-ambulatory residents in care, two of which are on hospice, and none are bedridden.

The facility is a single-story home. There are a total of six bedrooms, three are three resident bedrooms, and three staff bedrooms. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff bedrooms to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two and a half bathrooms, one and a half bathrooms are for residents and one is for staff. Continued on LIC 809-C.