Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for five non-ambulatory residents. Facility has an approved hospice waiver for four residents and the home currently has four residents, with no residents on hospice. Administrator (AD) Jose Jimenez arrived shortly to conduct facility tour.

LPA along with AD toured the facility at 1:33 PM. LPA toured the physical plant, checked food service, and facility documentation. The two story home consists of three resident bedrooms, living room, dining room, kitchen, and two bathrooms and an attached garage on the first floor. The second floor consists of three bedrooms and a bathroom. No residents reside on the second floor. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 111.9 degrees F and 113.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. LPA reviewed the infection control and emergency disaster plans. Facility conducts quarterly emergency drills with the last drill conducted on 3/1/2026. Outside grounds were toured. There is shaded outdoor seating for residents. Exit gate is unlocked and operational.