Facility Evaluation Report

Licensing Program Analyst (LPA) E. Conchas conducted an announced annual visit to the facility. LPA was greeted and granted entrance by Licensee David Corpin.

The facility is a four (4) bedroom three (3) bath home. The capacity for the facility is four (4). That may be non-ambulatory and or four (4) bedridden residents. The facility has a Hospice and Dementia waiver. The facility currently has zero (0) staff and zero (0) residents. The facility has fire clearance approved and extinguishers service date due May 27, 2026. LPA observed that the client bedrooms were appropriately furnished with the required furniture, lighting and space. LPA observed the restrooms to be functional and with the required grab bars and nonslip mats. LPA measured water temperatures to be between 110.1 -114.8. LPA observed the required posters posted in the common area. LPA reviewed records and licensee is the administrator and has the required updated documents. LPA observed liability was not renewed, a deficiency was cited. LPA observed designated medication and sharps cabinet to be locked. LPA observed facility to have sufficient food supply.

LPA was informed by licensee of a potential closure for the facility. Licensee stated will make their final decision by the end of May 2026. LPA informed licensee to update the Regional Office if they decide to close. At this time LPA did not observe additional staff and evidence of residents residing during the visit.

An exit interview was conducted where this report was discussed and provided to the Licensee David Corpin .