Facility Evaluation Report

Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced on 11/21/25 at 2:15PM to conduct a Required - 1 Year inspection visit. LPA met with Clifford G. Tejada., Administrator, and explained the purpose of the visit. The Administrator certificate for Clifford G. Tejada expires 6/3/27.

The facility is licensed for a capacity of 6 residents. The census is 4. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. Facility fees were paid on 09/18/25. LPA observed the most recent emergency drill was conducted on 09/22/25, 4 clients and 3 staff participated and the drill last less than a minute.

LPA observed kitchen, dining area, bedrooms and bathrooms, storage areas, laundry and lighting throughout the facility. LPA observed supplies of non-perishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises.

LPA observed the facility handles P & I monies and there is no commingling of the monies which are logged and accounted for during this visit. Facility has a Infection Control Plan on file. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 106.3*F which is within the required range of 105-120*F.

LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility.