Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct a Required Annual inspection of the facility. LPA was welcomed by staff Elia Cuevas who contacted Licensee Kelly Eriksen that arrived shortly after. Facility is a single story 5 bedroom RCFE with a fire clearance for 6 Non ambulatory of which 1 may be bedridden. Currently there is 5 residents at the facility, 2 with a diagnosis of dementia and 2 currently on Hospice.

LPA toured the facility on 715/2025 at approximately 8:30 AM with staff; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The facility serves residents with dementia and has a plan of operation for special care and programming. Exits were equipped with auditory devices which were activated and working properly at the time of the visit. Fire Extinguishers were found to be last charged 1/12/2025 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 106.3 degrees F and 109.2 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator was properly stored as per regulations on this day at the time of the visit. Toxins are stored locked under the sink in kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. All bedrooms have lighting & appropriate furnishings per Title 22 regulations.