Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Licensee, Dominica Oliva and stated the purpose of today's visit. LPA Rai observed 4 staff and 5 residents at the facility.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

LPA Rai toured the facility to include 6 resident rooms, 2 staff room, living room, dining room, kitchen and garage. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights. 4 Out of 4 facility bathrooms had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sinks ranged from 113.5 - 117.1 degrees F.

Fire extinguisher was observed and inspected on 05/18/2026. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 04/15/2026 and 01/12/2026. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Dominica Oliva and a copy of the report was provided. LIC 858 and LIC 859 were provided.