Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The facility is licensed for six non-ambulatory residents with a hospice waiver for four. The facility is a single-story home with four private resident bedrooms, three bathrooms, a living room, a family room, a dining room, a kitchen, a laundry room, and an unattached three car garage. There is a secured pool in backyard.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in resident bathrooms. The hot water temperature measured at 118.5 to 120 Fahrenheit and all smoke detectors were operational. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication in locked cabinet in laundry room.

LPA reviewed two out of two staff fingerprint records. LPA did not observe staff training records for Staff 1. LPA conducted a complete review of all resident records. LPA confirmed that administrator has submitted for renewal of administrator certification on June 5, 2026.

Based on observations made a deficiency is being cited during today's visit. An exit interview was conducted and a copy of this report was provided.