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, based upon the deficiencies cited in LIC form 809D on 07/09/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit.

*Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Spaces has been cleared. During today's visit, Noted items have been secured. Licensee has complied with the terms of the POC.

*Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. During today's visit, medications are secured in a locked cabinet. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87303(a ) pertaining to Maintenance and Operation has NOT been cleared. During today's visit, LPA observed multiple pieces of wood and debris in backyard. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED.

*Deficiency cited under Title 22 Regulation 87303(e)(2 ) pertaining to Water temperature has been cleared. During today's visit, water temperature is in compliance. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87303(e)(2 ) pertaining to Personal Accommodations and Services has been cleared. LPA observed protective mechanisms on the cook top knobs. Licensee has complied with the POC.