Facility Evaluation Report

On 07/16/2025 at 9:02 am, Licensing Program Analyst (LPA) Cynthia Tamayo arrived at the facility to conduct an unannounced annual inspection. LPA Tamayo met with caregiver/staff Isilisa Tedlos (S2)and explained the purpose of the visit. S2 called the facility designated administrator/licensee to inform that CCLD was present in the facility. An initial attempted visit was made on 7/101/2025.

This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present.

LPA's toured the kitchen, pantry, and refrigerators and observed sufficient seven-day non-perishable and two-day perishable food supplies. LPA observed there were small cockroaches in the recreation room desk, kitchen floor, and resident bathroom counter. S1 stated there has been over the counter pest control treatment has been applied and the Licensee will schedule an exterminator. Hot water temperature was measured at 110.6 degrees Fahrenheit in kitchen and bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. one fire extinguisher is located in the dining room and another in the hallway by the office, they were last serviced on 2/28/2025.