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 four (4) non-ambulatory clients with a hospice waiver for 2. The facility has a current census of 4 clients in care and zero clients on hospice. The facility is a six bedroom, level 4i, single story building.

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 at 109.7 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an earthquake drill on October 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 secured medication storage in locked cabinet located in dining room. LPA observed emergency food and water in a closet in the entryway of the facility.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of four out of four client files. LPA confirmed that administrator has a current administrator certificate which expires on April 27th, 2026.

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