Facility Evaluation Report

On 5/19/2026 at 11:20 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Caregiver John Belleza and was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present.

The facility is a five (5) bedrooms, two (2) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and six (6) hospice care waiver and the current census is four (4) residents. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 79 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 144 degrees Fahrenheit. Deficiency issued. The facility is equipped with a combined operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility.LPA observed the fire extigushers were not certified. Deficiency issued. Posters such as personal rights, the CCLD complaint poster. and the disaster plan was posted in a common area. LPA observed that the facility do not have an activity calendar posted. Deficiency issued.