Facility Evaluation Report

Unannounced annual visit made out to this facility on 06/27/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility on-call staff person, Sandra Glover, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Arlyn De la Cruz, to inform her that CCL was present at this time for an annual visit.

This LPA was able to speak with the facility designated Administrator, Arlyn De la Cruz, on the phone and learned that she was at a personal engagement, funeral service, and would not be able to attend and be present for this annual visit at this time. She indicated that all authority was given to the caregiver, Sandra Glover, who was currently present to be able to sign and engage with this LPA at this time.

It was learned that the husband, Juanito De la Cruz, was out of the facility at this time due to a personal medical appointment and would be available later on once his appointment had been fulfilled.

Juanito De la Cruz did arrive later to this facility after this LPA had toured and was in the process of conducting the file review for this annual visit.

Current census was 5 residents. Tour of the facility was conducted.

Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient, in good repair, and able to meet the needs of the residents at this time.

Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed at this time. Items for preparing, cooking, and serving meals unto the residents were observed to be sufficient and in compliance at this time.

Cleaners and cleaning agents were observed to be locked and made inaccessible to the residents at this time.

Fire extinguisher, located hanging on the wall adjacent to the refrigerator, was observed to have been annually inspected on 12/13/2024 by the local fire extinguisher company, Jorgensen Fire, and was in