Facility Evaluation Report

Licensing Program Analyst (LPA), Alviso conducted a required -1 year inspection, at approximately 2:25pm 8/6/2025, and met with Licensee Teddy Rico. There are currently six (6) residents in care.

Fire clearance is approved for six (6) non-ambulatory only. The facility has a staff room for three live-in caregivers. The facility's last emergency disaster drill was conducted on 5/18/2025. The facility does have emergency food/water and emergency supplies to meet the "72 hour shelter in place" requirements.

Facility has an approved dementia plan of operation. Facility has a hospice waiver approval for two (2) residents. Facility has a required infection control plan and emergency disaster plan.

LPA reviewed six (6) resident files. All files were complete.

LPA reviewed five (5) staff files. All staff had criminal record clearance as required. LPA reviewed staff annual training. Staff S2 & S3 have first aid certification and CPR certification.

Hot water was measured at 111.7 degrees Fahrenheit. LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, linens, cleaning supplies, and paper products for use as needed. All exits were free and clear of obstruction. Fire extinguisher was charged, in the green area, tag expires 10/2025. The facility was at a comfortable temperature for residents; Residents were observed to be watching television, listening to music, and engaging with the staff. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed; Facility has a sufficient supply of personal protective equipment(PPE). All medications were stored, locked up, and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. The backyard has a shade covered sitting area for residents in care.