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 one residents in care. 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 109.7 to 111.5 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill in July 1, 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 secured medication storage. LPA observed emergency food in facility garage and emergency water in facility garage.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of one resident record. LPA confirmed that administrator has submitted for renewal of administrator certificate.

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