Facility Evaluation Report

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 04/28/25. LPA identified herself upon arrival, stated the purpose of the visit, and met with the Licensee/Administrator, Flordeliza Navarro. A brief interview followed. LPA presented Licensee/Administrator with a list of documents to be collected during this visit: LIC 500, LIC 9020, LIC 308, LIC 405, LIC 610E, a copy of liability insurance, updated facility sketch, and a copy of the Designated Facility Administrator's Certificate (# 7016947735, expires 08/19/26).

The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. LPA pulled a sample of 9 items from the refrigerator, all but 2 had the appropriate packaging and dates on them as required. The 2 that did not were leftovers from staff. LPA provided technical assistance and highlighted that all opened packages needed to be dated and labeled and that if they belonged to staff, they need to be labeled as such.

LPA compared the facility sketch to the current floor plan and they were identical with no changes. LPA inspected the 4 resident bedrooms. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time.

LPA noted soap, paper towels, and trash cans in the bathrooms. The hot water temperature was measured at 113.2 degrees Fahrenheit and was in compliance. The fire extinguisher was last serviced on 02/05/25 by Jorgenson Fire and was also in compliance.