Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility to conduct an Annual Required inspection. LPA was greeted and granted entry by staff and explained the reason for the visit.

The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which two may be on hospice. The facility currently has a census of five residents.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors. LPA observed smoke detectors were operational. The facility’s last fire drill was conducted on Janurary 31, 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 unsecured medications and unsecured toxins in kitchen. LPA observed postural supports without physician's orders. Administrator stated they did not have emergency food and water. LPA observed expired food in kitchen pantry. LPA observed 5 out of 5 residents did not have a Needs and Services plan completed.

LPA reviewed two out of two staff training and fingerprint records. LPA conducted a complete review of resident records.

Based on observations made deficiencies are being cited per Title 22. An exit interview was conducted and a copy of this report was provided.