Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Alex Rodriguez. Administrator Jackeline Gilbo arrived during the visit.

The Administrator for the facility is Jackeline Gilbo and their certificate was valid and current. The facility is licensed for a maximum capacity of 6 ambulatory clients on the first floor only. During today’s visit, the facility had a census of 4 clients, 2 of which were deemed non-ambulatory by assessment records, Clients 1 and 2. [LPA provided Administrators with an LIC811 Confidential Names List to identify C1 and C2] Administrators Gilbo and Rodriguez stated that both clients ambulated without the use of assisted devices and were able to follow staff direction to evacuate the facility in case of emergency. Administrators Gilbo and Rodriguez stated that in the case of C2, the assessment and medical records did not reflect C2's current condition and ambulatory status. LPA was also able to observe that C1 was able to ambulate without assistance and was able to respond to staff questions. LPA provided guidance regarding fire clearance requirements on a Technical Violation LIC9102TV form.

During visits on 4/21/2025 and 5/1/2025, LPA toured the facility and inspected each room of the facility, including client and staff rooms, bathrooms for client and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 108.4 and 113.4 degrees Fahrenheit in common bathrooms and 114.1 degrees F in a private client bathroom.