Facility Evaluation Report

At approximately 12:45 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year inspection and was greeted by caregiver Demetrio Salva who has Designation of Facility Responsibility (RP). RP called licensee Leslie Ann Pascua to advise of today's inspection. Licensee arrived at approximatly 01:15 PM to further assist with today's required inspection. During today's inspection, a resident that would normally be away at a day program is home after a private appointment with the licensee.

Facility was vendorized with North Bay Regional Center (NBRC) in June of 2025 and currently the facility has one (1) resident in care. Licensee indicates that NBRC plans to only send them 4 residents and they may look to convert one or two bedrooms to staff room on their facility sketch. Currently fire clearance has been approved for five (5) non-ambulatory residents. Facility has a waiver for three (3) residents receiving hospice services. Facility has a dementia plan on file with Community Care Licensing (CCL).

At approximately 1:00 PM, LPA initiated a tour of the facility and observed the following: Facility is a one story home with auditory signals activated on all exits, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured at approximately 109 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed 4 of 4 bathrooms had required anti-slip mats and grab bars. LPA observed a supply of incontinent care products and paper products available to residents. LPA observed adequate supply of towels, bedding sheets, and hygiene products. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations.

Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked.