Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Francis Parilla. Administrator (AD) Julie Cornejo arrived at approximately 12:00 p.m. and the purpose of the inspection was discussed.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a one-story home, consisting of four resident bedrooms, one staff room, three bathrooms, and attached two-car garage. LPA observed Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) posted in the main entryway of the facility met regulatory 20” x 26” in size requirement. All resident bedrooms had the required furnishings. LPA observed all residents’ beds had linens and blankets. LPA observed three of five residents leaving for mass and observed two of five residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 109.9 degrees Fahrenheit. LPA observed the backyard has a shaded sitting area and the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged with service tags dated June 30, 2026. Gas stove, microwave, laundry washer and dryer were all observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed five of five resident files and three staff files. Two of five resident files did not include an examination for Communicable tuberculosis; a Deficiency was cited on today’s date. (Cont. LIC809-C)