Facility Evaluation Report

On 04/21/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct the annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked staff to contact the designated facility administrator. Shortly thereafter, Kiesha Leggs, Designee, arrived and a brief interview followed.

LPA compared the Guardian roster to the LIC 500 presented by the Designee to ensure that all staff had the proper background clearances. All were in compliance at the time of this inspection. LPA also reviewed 2 staff files and 2 resident files and all were in compliance.

LPA reviewed Administrator and facility contact information with Designee. LPA directed Designee to submit an updated LIC 200 with all the appropriate changes to CCLASCPSacramentoSounthRO@dss.ca.gov with a copy to Kimberly.Viarella@dss.ca.gov by the close of business on 4/24/26.

LPA and Designee conducted a walkthrough of the facility, beginning in the kitchen. LPA observed a two-day perishable supply and a seven-day supply of non-perishable supply of food. LPA provided suggestions for emergency food supply items. LPA toured all common areas, bathrooms, laundry room, the medication room and the office. Resident rooms all contained the necessary furniture, furnishings and lighting to be in compliance at the time of this inspection. LPA also observed that the (2) fire extinguishers were last inspected on 10/01/25 by Jorgensen Co.

LPA and Designee toured the exterior of the facility. All windows and screens were in good repair. There was one shed in disrepair. The door had separated from its hinges and the roof had holes in it. Designee stated that it was no longer used. LPA provided technical assistance in this area and stated that because it was