Facility Evaluation Report

05/01/2025, Licensing Program Analyst (LPA) Loera conducted an Annual Required – 1 yr. inspection visit for this facility. There are currently no residents in care. Facility approved/cleared for 6 non-ambulatory, 1 bedridden, and hospice waiver for 6. Facility hasn't had any residents in care since February 2025.

LPA and House Manager toured the building and grounds. All rooms were furnished per regulation. All rooms were in good repair. Extra linens were available. Water temperature in sinks were measured within the range of 105 to 120 degrees F. Fire extinguishers were charged. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located in the laundry room and under the kitchen sink and found to be secured.

No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/02/2025:

Admission Policies and Procedures/Admission Agreement

Exit interview conducted with House Manager and a copy of this report was provided .