Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit as well as a health and safety visit based upon the deficiencies cited in LIC form 809D on 03/24/2026 and 04/10/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit.

*Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Criminal Background Association has been cleared. Licensee associated staff to the facility. Licensee has complied with the terms of the POC.

*Deficiency cited under Title 22 Regulation 87465(h) (2) pertaining to Centrally Stored Medication has been cleared. Medication is secured during today's visit. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Licensee repaired noted items. Licensee has complied with the POC.

LPA toured the facility and observed residents relaxing in the facility. Facility appears clean and sanitary. There are 5 residents, one staff, Licensee and Licensee's spouse present at the facility. LPA observed ample food and water supply. No health or safety concerns noted during today's visit.

Licensee has been advised to maintain all items previously cited.

Exit interview conducted and a copy of this report was left at the facility.