Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Violeta Dumo. During the visit, LPA observed 3 residents and 2 staff. LPA explained the purpose of the visit. (Evergreen Adult Residential Care is a level 3 home.)

As LPA entered the facility, LPA asked for the names of the staff present and cross referenced with LIC536, facility personnel Report Summary. LPA observed staff S1's name was not on the facility personnel Report summary. ADM stated S1 is shadowing today. LPA searched S1 on guardian, which states S1 is fingerprint cleared. ADM acknowledged that staff S1 was not associated with the facility.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured to range from 108-112 degrees F in both resident bathrooms.

Fire extinguisher was serviced in May 15, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on March 20, 2025. .