Facility Evaluation Report

On 02/23/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Staff Member (SM), Vivaleene Hernandez and explained the purpose of the visit. LPA Pascua also identified a second Staff Member (SM), Shannon McGurk. LPA Pascua asked SM McGurk and Hernandez to call Facility Designated Administrator (FDA), Ricky Nolasco to inform him that CCL was present at this time. Shortly after, LPA Pascua was greeted by FDA Nolasco.

This facility is licensed to serve and retain 6 elderly residents of which all may be ambulatory.

This facility also holds a dementia plan on file and a hospice waiver for 3 residents. There are currently 2 residents in care obtaining hospice services.

Current census was 6. A brief interview with FDA Nolasco was conducted.

LPA Pascua reviewed 6 resident files. Upon review, LPA Pascua observed that the facility currently has 5 non-ambulatory residents per physicians reports on file. 6 out 6 resident files did not have a complete needs and services plan. 1 out 6 residents did not have a current LIC602 upon admission on 11/11/2025 with a current TB test. LPA Pascua reviewed 3 staff files. All staff files were complete and up to date. All staff have a current CPR/FIrst Aid certificate on file. The facility administrator has a current administrator certificate #7023411740 and expires on 09/28/2026.

A tour of the facility was conducted. LPA Pascua reviewed the facility sketch and identified 4 resident bedrooms. LPA Pascua also identified the garage which has been converted into a living space for a staff member. LPA Pascua reviewed the current facility sketch with FDA Nolasco and asked for an updated facility sketch to properly identify the changes in the facility.