Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Program Manager (PM) Jose Rodriguez & Clinic Manager (CM) Samantha Tricarico and stated the purpose of today's visit. LPA Rai observed 7 residents in the common areas of 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 observed 2 shed in the backyard which was locked and used for storage and not habitual space. 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.

LPA Rai toured the facility to include at random 3 resident rooms, nurse's station, kitchen, offices and 2 common areas. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sinks ranged from 105.4 - 105.6 degrees F.

Fire extinguisher was observed and inspected on 7/30/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 12/23/2025 and 10/25/2025. LPA Rai observed a complete first aid kit at the facility.

LPA Rai reviewed facility records for 5 staff and 5 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 Program Manager (PM) Jose Rodriguez & Clinic Manager (CM) Samantha Tricarico and a copy of the report was provided. LIC 858 and LIC 859 were provided. LPA Rai provided PIN 25-11-ASC Adult Care Facilities Reference Guides to Administrator, Staff and Volunteer Training Requirements during today's visit.