Facility Evaluation Report

At approximately 11:30, Licensing Program Analyst(LPA) Contreras arrived unannounced to conduct required annual inspection for facility. LPA was greeted by licensee Jasmin Hermano. Facility is residential care facility for the elderly approved for a capacity of 4 residents with a hospice waiver granted for 2. Facility has not had any residents since licensed due to closed vendorization. Licensee does plan on having residents and is still awaiting residents from North Bay Regional Center.

LPA and licensee toured the building and grounds which was found to be clean and in good repair. Facility was 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 6/21/2025. Fire alarms and carbon monoxide detector were tested and operational. Backyard had patio furniture and outdoor emergency exit clear from obstruction. Toxins and sharps all have locks but not currently in use. Licensee will use locks once there are residing residents. Emergency water and food supply was stored in garage. Emergency kit available. Water temperature measured at 110 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. Licensee resides at facility. Current family member is occupying bedroom, licensee stated room will be available once residents move in. All other resident bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair.

Medication cabinet is locked and will not be accessible to residents. No current medications at facility.

File review was not conducted due to there being no residing residents or current employees.

LPA requests that Licensee inform CCL when they are ready to begin accepting residents so that facility compliance can be reviewed.

No deficiencies given. Copy of report given.