Facility Evaluation Report

On 8/6/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with one of the staff on duty and stated the purpose of the visit. The current administrator Grant Depositar was notified and arrived shortly after.

Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 non-ambulatory residents, ages 60 and above. Facility has hospice waiver for 4 residents. Facility has 6 resident bedrooms and three bathrooms, and one staff room. Bedroom #2 on the facility sketch was approved for bedridden use.

Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 5 of 6 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. LPA measured the hot water temperature in the 1 of 3 bathrooms to be at 117 degrees Fahrenheit. Bathrooms were observed to be in clean. The hallway bathroom sink cabinet was observed to be not locking properly. Advisory was provided to fix the lock. Room temperature was at 76 degrees Fahrenheit.Fire extinguisher was observed and last inspected on 2/6/2025. Smoke and carbon monoxide detectors were observed throughout.

In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Insect spray was observed stored in the pantry. LPA observed a Rubitussin medication inside the kitchen refrigerator. Staff immediately placed the medication in a locked area.