Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility 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 six may be on hospice. The facility currently has a census of five residents with 1 resident on hospice.

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 two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 114 and 114.6 degrees Fahrenheit and all smoke detectors were operational.

The facility’s last fire drill was conducted on March 30th 2026. 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 pre poured medication in a kitchen drawer.

LPA reviewed two out of two staff training and fingerprint records. Per review Staff 2 did not have a health screening on record. LPA conducted a complete review of resident records. LPA observed Resident 1 and Resident 3 had hospital discharge paperwork per review of incident reports no incidents were reported to the Department. LPA observed Residents 1-3 did not have updated physician's report or documentation of an annual visit.

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