Facility Evaluation Report

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to the facility to conduct an one year required inspection. LPA Lund met with Juanito De La Cruz and explained the purpose of the visit.

LPA Lund and Juanito De La Cruz toured/inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility is licensed for six ambulatory residents, which two may be non-ambulatory and reside in bedroom two. There are currently 5 residents who reside at this facility. LPA Lund reviewed two staff files and three resident files, which were maintained. The facility has the required postings throughout the facility. LPA Lund reviewed 3 medication administration records (MARs), which were maintained. Fire extinguisher (12/12/2025), smoke detectors, and carbon detectors were in good repair and in compliance. The water temperature measured at 110 degrees and facility temperature measured at 70 degrees. The facility had an adequate food supply, and all toxins were stored in a locked cabinet.

No deficiencies cited. An exit interview was conducted, and a copy of this report.