Facility Evaluation Report

On 02/25/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was met and greeted by Facility Designated Administrator (FDA), Brandon Rose and explained the purpose of the visit. There was one other staff member present at the facility, Alejandra Miranda Caballero.

Current census was 5. A brief interview with FDA Rose was conducted.

This facility is licensed to serve and retain 6 non-ambulatory elderly residents. 1 out 6 residents may be bedridden residing in bedrooms 1 or 3. In addition, this facility has a dementia plan on file and a hospice waiver for 4 residents. It was learned that there are currently 0 residents on hospice at this time and there is 1 resident currently on home health.

LPA Pascua reviewed 3 staff files. All staff members currently working at the facility have all completed documentation. The facility administrator has an active administrator certificate #7009243740 and expires on 06/04/2026. LPA Pascua reviewed 5 resident files. 5 out 5 residents were observed to have outdated needs and services plans. LPA Pascua provided technical assistance regarding Dementia regulations, best practices regarding physicians reports and needs and services plans.

A tour of the kitchen was conducted. LPA Pascua observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply. 2 fire extinguishers were present at the facility and were serviced on 02/11/2026 by Jorgenson Co. Smoke detectors and carbon monoxide was observed to be present and in working condition.

Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time.