Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year visit, on 1/14/26 at approximately 1:00pm, and met with Administrator Monicah Gacegu.

Fire clearance is approved for eight (8) non-ambulatory only. Currently there are five (5) residents' in care.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan.

LPA reviewed five (5) resident files, including storage of medications and medication records. All files were complete. LPA reviewed resident's hospice file, including medication orders.

LPA reviewed three (3) staff files, including training. All staff have required criminal record clearance. All staff have first aid and CPR certification.

The annual will be continued at a later date by the Department.

LPA is requesting the following documents be updated and submitted by 2/14/26:

LIC308 - Designation of Administrator Responsibility

LIC610E-Emergency Disaster Plan, 9pg - (review & update as needed--submit if changes)

Infection Control Plan- (review & update as needed--submit if changes)

Copy of LIC400- Handling of Client Cash Resources-all care homes complete this form.

Copy of current Administrator certificate