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 a single story home with four private resident bedrooms, one staff bedroom, four resident bathrooms, one staff bathroom, a living room, a dining room, a TV room, a kitchen, a laundry room, and an attached two car garage. The facility is licensed for 6 residents of which 5 may be non-ambulatory and 1 may be bedridden. The facility has a current census of 4 residents.

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 105.4 to 106.8 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. Facility conducted emergency earthquake drill on April 15, 2026. LPA Mendivil observed a secured medication cart stored in facility living room. LPA reviewed medication and medications appear to be given as prescribed.

LPA reviewed three out of three staff fingerprint records and records contained all required documents and training. LPA conducted a complete review of all resident records. LPA confirmed that administrator has a current administrator certificate which expires October 16, 2027.

Based on observations made, no deficiencies are being cited during today's visit. An exit interview was conducted and a copy of this report was provided.