Facility Evaluation Report

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

Facility is a single story house with 5 bedrooms, 2.5 bathrooms, and a three car attached garage. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are six residents of which three are on hospice during today's visit.

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 116 and 117.5 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill in 4/19/2025. 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. LPA observed emergency food in facility pantry and emergency water in facility garage.

LPA reviewed one of one staff training and fingerprint records and conducted a complete review of six out of six resident files. LPA confirmed that administrator has a current administrator certificate which expires on 03/22/2026.

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