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 4 non-ambulatory residents, 2 ambulatory residents which one can be bedridden. Facility has an approved hospice waiver for 4 residents and the home currently has 5 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 bathrooms. The hot water temperature measured between 110.3 and 111.1 degrees Fahrenheit and all smoke detectors were operational. The fire extinguishers are charged and were serviced on March 21st 2025. The facility’s last fire drill was conducted on December 8th 2025. 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 hallway closet. LPA observed emergency food and water in facility garage. .

LPA reviewed three of three 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 3rd 2026.

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