Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:25 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Alan Sepulveda and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility is a 6 bedroom and 4 ½ bathroom, with 1 bedroom and ½ bathroom dedicated to staff. The facility is occupying 6 residents and employs 5 staff of which one is the Administrator, and one is a live in staff. The facility is clean, safe and sanitary, areas that need additional upkeep were noted to the administrator. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. Carbon Monoxide was tested and working properly and fire alarm was tested and working. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats and/or flooring. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are stored under kitchen sink and in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The backyard has a locked shed to store extra furniture and items.

Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 03/20/2026. The facility is approved for a capacity of 6 non-Ambulatory and approved for hospice waiver of 6.