Facility Evaluation Report

On 10/16/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Facility Designated Adminsitrator (FDA), Arabella Mathis and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit.

There were two other staff members present at the time of this visit, Michael Joshua Doromal and Mary Joy Geron.

Current census was 3. A brief interview with applicant Mathis was conducted.

This facility will hold 3 ambulatory residents in bedrooms #1, #2, and #4 with one non-ambulatory resident in bedroom #3 with a direct exit. This facility also plans to hold and accept Level 4 Residents from Alta Regional Center.

The applicant has an active adult residential administrator certificate #6065286735 and expires on 09/08/2025.

LPA reviewed 3 resident files and 3 staff files. It was learned that 1 out 3 staff member present was not associated to this facility. LPA Pascua provided guidance at the time of the visit to assist the facility in associating S1. In addition, additional technical assistance was provided to this facility regarding resident and staff files. The facility administrator has an active administrator certificate #7029940735 and expires on 09/09/2027. All resident files and all staff files were complete and up to date at this time.

LPA Pascua initiated a tour of the facility with Applicant, Arabella Mathis.

One fire extinguisher was placed in the kitchen and was serviced by River City Equipment Company on 06/21/2024. Smoke detectors and carbon monoxide detectors were located throughout the facility and were observed to be functional and in compliance at this time.