Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection LPA met with Diwata Vallejo, and Aizza Gonzales, Assistant Administrator/caregiver. Administrator Designee, Russelle Robinson, who is also a certified Administrator was present. The facility is licensed for (6) non-ambulatory residents, (1) of whom may bedridden, and has a hospice waiver for (4). Currently, no residents are under hospice care. LPA observed (1) resident in the common area and (4) residents in their rooms.

LPA and the Administrator Designee toured the interior/exterior of the facility including the common areas, (6) resident bedrooms with half bath, (2) full bathrooms, kitchen, staff room and locked laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms have the necessary grab bars, slip-resistant flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable, 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 inside temperature to be 75*F. Fire extinguisher was last serviced 6/3/25, and the facility conducts quarterly fire drills- will vary the type of drill and time of day.

LPA observed (2) unlocked gates from the inside back patio. There is not a pool or fountain. Administrator certificate #7022575740- (exp 6/14/26). Administrator Designee's certificate is current. All postings posted.

LPA reviewed (2) resident files and (4) staff files- Files were organized and contained current paperwork. LPA reviewed ordered medications for (1) resident- no discrepancies found. All staff is cleared and associated and has current First Aid/CPR, and has completed the required training in last 12 months, through an approved on-line provider. Dementia care paperwork is current. Obtained current liability insurance. All contact information is current.

There are no deficiencies issued. Exit interview with Administrator. Copy of report provided.