Facility Evaluation Report

On September 25, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual utilizing the inspection tool. LPA met with Administrator and explained the purpose of the visit. Today's visit, there are two (2) residents in care with one (1) resident on hospice services. Facility is compliance to license.

LPA observed Administrator Certificate to be expired but observed that Administrator is active via Community Care Licensing (CCL) website. LPA informed Administrator LPA will reach out to AdminCert for Administrator's active certificate.

Today's inspection, LPA and Administrator conducted a tour of the interior and exterior of the facility. LPA observed four residents bedrooms, bathrooms, laundry room, kitchen, backyard and the common areas. LPA observed facility to have sharps, toxins and medications to be locked and secured. LPA observed complete first aid kit present. LPA observed facility to have adequate food supplies for the residents in care. Exterior pathways were observed to be clear and free of obstructions. In areas observed, LPA did not observed any concerns and/or violations. Facility was found to be clean, sanitary and in good repair.

File review was conducted for two residents in care. LPA observed residents records to be complete with the required documents. LPA advised Administrator of CCL's new updated LIC 602A. LPA was informed due to census, Administrator is the only active staff at this time. LPA observed Administrator's records to be complete. File review of facility fire drills observed to be compliance to regulation of conducting quarterly drills. LPA provided Administrator copies of LIC 602A and LIC610E. Care tool completed and found facility to be in compliance. No deficiencies cited.

Exit interview conducted and a copy was provided.