Facility Evaluation Report

On February 5, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA is following up on the visit that was conducted yesterday, please see LIC809 report dated February 4, 2026. In additional, the visit is being conducted in conjunction with the complaint visit for complaint control 22-AS-20260126155937. LPA was greeted and granted entry into the facility by Licensee (LI) Allen Medina after explaining the purpose for the visit.

On today's visit, the facility has a census of three residents, however, no residents were physically present during the visit. LPA, accompanied by the LI, conducted a tour of the physical plant. LPA inspected the five resident bedrooms and observed them to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the five bathrooms located in the facility, three of which are dedicated for resident use. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each bathroom was operational and hot water measured between 116 and 119.8 degrees Fahrenheit.

LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the six burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the kitchen pantry. LPA observed all of the facility's utilities, such as the electricity, gas, water, and internet, to be operational during the visit. CONTINUED ON LIC809-C