Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. 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 and has a hospice waiver for six. The facility is a single story home with four resident bedrooms, two of which are shared, one staff bedroom, three shared bathrooms, a living room, a dining room, a kitchen, a laundry room, and an unattached two car garage.

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 between 109 to 118.7 degrees 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 seventeen eggs left on the kitchen counter, staff confirmed it was placed on the counter since the morning. LPA observed over the counter medications on the top shelf of the kitchen cabinet that was unsecured. LPA observed Resident 1 and Resident 3 had half rails on their hospital beds without a physician's order. LPA observed Resident 2, Resident 4 and Resident 5 with full rails on their hospital beds and who were not on hospice.

LPA reviewed two out of two staff fingerprint records. LPA confirmed staff are background cleared and associated to the facility. LPA reviewed five out of five resident files. LPA confirmed Administrator has a current Administrator certificate that expires on November 11, 2026.

Based on observations made during today's visit deficiencies are being cited per Title 22. A copy of this report, appeal rights were provided to facility representative.