Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Sashana Barnett, caregiver, and explained purpose of inspection. Administrator, Gerald Rivera, arrived at 10:15 am. LPA observed (1) resident in the common area and (3) residents in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). Currently there is (1) resident on hospice.

LPA and the caregiver toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (4) private resident bedrooms, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, skid-resistant flooring, hygiene supplies, and a trash can with a lid. There is sufficient 2+day perishable food, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen, and medications are secured nearby. The fire extinguisher was last serviced 2/12/26. Disaster drills being conducted. Smoke/monoxide alarms are working. Inside temperature measured 71*F. Hot water temp measured 124*F in a resident bathroom (sign posted). There are sufficient linens/towels/blankets and PPE. Administrator Certificate #7026858740 (exp 12/26/27)- Administrator to post a current copy. The pool is currently filled with dirt and is gated/locked. Patio seating is covered. Required postings are visible in common area, including a facility sketch with utility shut off valve locations. Exit doors have alerts and there are no blockages present. Annual fees are due by 5/1/26.

LPA reviewed (2) resident and (2) staff files. Files were organized and contained required documentation. Medications were reviewed for (2) residents- orders matched medications being administered- an updated list will be obtained to reflect discontinued medications. Staff have current First Aid/CPR certifications. Updated copy of LIC308, LIC500 and insurance requested by 3/19/26. There are no deficiencies issued in this report . Exit interview. Copy of report provided to Administrator.