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.
The facility is a one-story home with five resident bedrooms, two bathrooms, living room, kitchen, dining room, staff room, laundry area, backyard and attached two car garage. Facility is licensed for 1 ambulatory, 5 non-ambulatory 1 of which may be bedridden.
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 112.2 and 112.4 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 3rd 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 cabinet in hallway. LPA observed emergency food and water in facility storage room. LPA observed over the counter medication in room 4 for Resident 1 (R1) and physician's report stated R1 is not allowed to store their own medications.
LPA reviewed four of four 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 July 19th 2026.
Based on observations the following is being cited per Title 22. An exit interview was conducted and a copy of this report was provided along with appeal rights.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction