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.

The facility is a single-story building with an approved fire clearance of six non-ambulatory residents, four of which may be on hospice. The facility currently has a census of four residents in care and three residents on hospice. The facility has six resident bedrooms, one staff bedroom, two and a half bathroom, living room, kitchen, dining room, and an attached two car 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 108 and 116.6 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill in May 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 three of three staff training and fingerprint records and conducted a complete review of four out of four clients files. LPA confirmed that administrator has a current administrator certificate which expires on 03/01/2026. LPA observed 1 staff member had obtained a background clearance but is not associated to the facility.

Based on observations made deficiencies are cited per Title 22. An exit interview was conducted and a copy of this report was provided along with civil penalty and appeal rights.