Facility Evaluation Report
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.
The facility is licensed for 6 non ambulatory residents of which 1 may be bedridden in room 4 only. The facility has a hospice waiver for 6 residents.
This facility is a one-story home with 4 residents’ bedrooms, 1 staff bedroom and 3 bathrooms with an attached garage.
During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in the bathrooms. The hot water temperature measured 114.9 and 120.6 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill on 09/12/2025. 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 secured medication storage in a secured kitchen cabinet. LPA observed emergency food in the kitchen pantry and water in facility garage.
LPA reviewed three out of three staff training and fingerprint records and conducted a complete review of 5 out of 5 residents files. Administrator has a current administrator certificate which expires on 08/28/2027.
No deficiencies noted. An exit interview was conducted and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction