Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 10/7/2025 at approximately 10:00am, and met with Administrator Assistant, Lorena Madrigal. Administrator Mera Shaughnessey would arrive later after their scheduled morning appointment.

There currently are six (6) residents residing in the facility; One (1) resident is currently hospitalized. Fire clearance is approved for six (6) non-ambulatory/bedridden residents, Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required.

Per record reviews, the facility conducted their last emergency disaster quarterly drill on April 4th & 5th, 2025. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements.

LPA observed eleven(11) of eleven(11) smoke alarms; Smoke alarm system is hardwired, and is a carbon monoxide detector as well. The smoke alarm system was working properly during the inspection.

LPA reviewed six (6) resident files. All files were complete. Two (2) residents are on hospice services.

The LPA reviewed four (4) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. LPA reviewed staff training.