Facility Evaluation Report

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to conduct the annual inspection, LPA met with the Facility Administrator Cecelia Reyes. the facility is licensed for 6 nonambulatory one of which may be 1 bedridden. There are 1 client has o2 administration, 2 have diabeites, 3 have dementia. 3 are non-ambulatory. There is not an exception on file for the o2 administration insulin dependant diabetes, Administrator will work the LPA to file the exeption paperwork, begining with a formal request for an exception to be recived by the LPA in writing, noel.wolfpetersen@dss.ca.gov by end of day tomorrow 1/29/2026

Physical inspection includes a converted garage, there are 4 rooms, Bedridden room on the facility sketch is designated as room 3 or room 4. Physical inspection included the kitchen, bedrooms, bathrooms, common areas, storage areas, exterior, and evacuation route gate. Evacuation route gate is obstructed by a heavy spring that renders an unnessisary resistance to opening the gate more than a 20*, LPA is asking the spring to be reinstalled to a position where the door could be opened 90*, or be removed. Administrator adjusted the spring tension.

Fire extinguisher is dated 10-17-25. CO/smoke alarm is functional, water temp is measured at 114.5*F.

LPA interviewed 1 client, 1 clients is out of the facility, 1 client retired for the evening. LPA interviewed 1 staff.