Facility Evaluation Report

At 10:00am on 09/11/2025 Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual inspection. LPA met with care giver Diane Sanchez announced who he is and the reason for the visit. LPA contacted Administrator on cell and administrator arrived to the facility during the inspection.

Care Giver and LPA conducted a physical tour of the facility. This facility is a 4 bedroom, 3 bathroom, living room, dining room, kitchen, medication room and den. There is a fenced back yard with table, chairs and umbrella for resident activities and visiting. LPA noted that there was a local power outage during this annual inspection and staff were able to navigate the emergency disaster plan, turn on and utilize the facility generator to preserve integrity of cold storage medication. Medication refrigerator has a pad lock and all other medication is stored in the facility medication room adjacent to the dining room. LPA noted that smoke detectors and carbon monoxide detectors were tested and functioning during inspection. LPA noted that there are at least three days of perishable foods and seven days of nonperishable foods on hand for six residents and staff. LPA noted that the water temperature was tested throughout the facility within regulation range, and LPA reminded care givers to test water temperature later in the day due to the power outage during the annual inspection. LPA noted that the facility has a complete first aide kit on hand. LPA observed fire extinguisher primed and in the green. LPA noted that all passage ways, door ways and exits were free and clear. LPA conducted cursory reviews of staff files, training, resident files, emergency disaster plan, infection control plan, and facility Plan of Operation. There were no violations or citations as a result of the facility annual physical tour.

Administrator and LPA conducted a full reviewed of the annual care tools modules with no violations or citations. At this time there are no violations or citations as a result the facility annual inspection.

Exit interview, report read, and report provided.