Facility Evaluation Report

On July 7, 2025, at 1:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Staff Julie Cornejo and explained the purpose of the visit.

The facility is licensed to operate for six (6) non-ambulatory, of which one (1) can be bedridden and has a hospice waiver for six (6) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) residents bedrooms, one (1) staff bedroom, three (3) bathrooms, an attached 2-car garage, living area, dining area, kitchen, and an outdoor covered seating area.

LPA Kim toured inside and outside of the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: resident room 1, resident room 2, resident room 3, and resident room 4. Bathrooms were found to be clean and operational. The water temperature measured between 110.6 degrees F and 111.9 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C