Facility Evaluation Report

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

Facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden. Facility has a hospice waiver for 6 residents, currently 2 residents are on hospice. Facility is a single story, 7 bedroom, 3 bathroom house with an attached garage and an off white exterior. The exit gates are unlocked and self latching.

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 bathrooms. The hot water temperature measured between 111.7 and 117.5 degrees Fahrenheit and all smoke detectors were operational. The fire extinguishers are charged and were serviced on January 27, 2026. The facility’s last fire drill was conducted on February 4th, 2026. 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 storage in locked in kitchen cabinet. LPA observed emergency food and water stored in closet located in entryway of the facility.

LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on June 11th, 2026.

Based on observations no deficiencies noted. An exit interview was conducted and a copy of this report was provided.