Facility Evaluation Report

At approximately 2:45, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by staff Anecita Judilla. Licensee and administrator Annalee Gomez arrived shortly after. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for a capacity of 6 non-ambulatory which 3 can be bedridden. Facility is a one story home with currently six (6) residents in care. LPA arrived and found that staff S1 whom first day started on 2/01/26 not associated to facility Guardian Roster. S1 fingerprint cleared. Admin stated LIC9182 was sent to CCLD, LPA called office and was unable to locate fax. Admin resent LIC9182 during inspection. LPA advised admin that all staff needs to be associated prior to working in facility.

LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 6/30/2025. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. Outdoor furniture accessible for resident use. Water temperature measured within regulation at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. All bedrooms were equipped with lighting, a night stand and chest of drawers. Resident bathroom observed to have bath mat and grab bar. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Snacks accessible for residents. Emergency food was observed to meet the 72 hour emergency supply. Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. Toxins are locked and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Last disaster drill conducted 12/25/25.

LPA will return at another time to complete inspection for file review and medication check.

Copy of report given and read with administrator.