Facility Evaluation Report

On 03/07/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Facility Designated Representative (FDR), Allan Jose and JJ Jose and explained the purpose of the visit.

Current census was 5. Upon arrival LPA Pascua observed 2 residents leaving the facility for a weekend outing.

This facility is licensed to serve residents who at 60 and older, 4 out 6 residents may be non-ambulatory but cannot reside in the middle bedroom. This facility also has a dementia plan on file and has a hospice waiver for 2 residents.

This facility is also vendorized by Valley Mountain Regional Center to accept and retain Level 7 residents. There is current 1 resident on hospice, 1 resident obtaining home health services.

LPA Pascua reviewed 5 resident files and 5 staff files. LPA Pascua provided technical assistance to FDR Jose regarding dementia regulations, physicians reports, needs and services plans, and administrator certification.

Fire extinguisher located by the back door appeared to have been serviced 07/29/2025 by Jorgenson Co and is in compliance.

The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time.