Facility Evaluation Report

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Required-1 Year inspection. LPA met with Staff S1 Merly Bolando. LPA stated the purpose of the visit. S1 called Administrator (ADM) Grace Menor and ADM authorized S1 to sign on her behalf. ADM was in a meeting off-site and unable to attend the annual inspection. LPA observed 3 staff and 5 residents.

LPA toured the facility inside and out with S1 to include but not limited to the kitchen, bathrooms, resident rooms, living room and dining area. All exit and passageways were free and clear of obstruction.

LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the medication storage area, knives storage area, and cleaning product storage areas in the kitchen were locked and inaccessible to residents in care. The facility thermostat temperature display was observed at 71 F. LPA measured hot water temperature with a range of 110 to 112.6 F. The facility is equipped with smoke detectors and functioned properly when tested by the facility staff. The facility emergency drill logs were reviewed. The facility's last drill was conducted on 11/18/2025. The facility is conducting drills monthly. The facility fire extinguisher was inspected on 11/14/2025.

LPA reviewed 2 resident records, 2 resident's Centrally Stored Medication and Destruction Records (CSMDRs) and 2 residents P & I. LPA reviewed 3 staff files.

No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted with S1 Merly Bolando and a copy of this report was provided.