Facility Evaluation Report

On 08/07/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived to the facility unannounced to conduct an annual visit. LPA was greeted by Facility Designated Representative, Jesusa Gavero and explained the purpose of the visit. There was one other staff members present at the facility, Charles Gavero. It was learned that the Facility Designated Administrator (FDA), was unable to come to the facility at this time. LPA continued the visit with FDR Gavero.

This facility is licensed to serve and retain 6 residents who are 60 and over of which may be all non-ambulatory. This facility also holds a dementia plan on file.

Current Census was 6. A brief interview with FDR Gavero was conducted.

LPA reviewed 6 resident files were reviewed. 6 out of 6 resident files were complete and up to date.

LPA reviewed 3 staff files were reviewed. 3 out 3 staff files were complete and up to date. The Facility Designated Administrator has a current administrator certificate #7005301740 and expires on 09/06/2026.

A tour of the facility was conducted. There are currently two fire extinguishers located throughout the facility and have been serviced by Coast Fire Equipment on 04/23/2025. Smoke alarms and carbon monoxide detectors were present and in compliance. Last emergency safety drill was conducted with residents on 04/02/2025.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen.

LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.

The exterior of the physical plant was toured with no hazards present. One exit gate was inspected and the perimeter fence was observed to be stable.