Facility Evaluation Report

Licensing Program Analysts (LPA) Alviso conducted a Required- 1 Year visit, on 4/15/25 at approximately 10:20am, and was greeted by lead staff Liza Fonseca. LPA observed a second caregiver, Ashley, working at the facility. Lead staff Fonseca has a current RCFE administrator certificate. There are six (6) residents in care.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has a required emergency and disaster plan.

Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. Room #1 and #2 are fire cleared for bedridden use. Fire extinguishers were serviced and tagged as required. Facility has a carbon monoxide detector that worked properly during the inspection. All smoke alarms are hard wired and worked properly during the inspection. All exits were clear and unobstructed.

The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Per review of records, emergency disaster drills have been conducted as required; Last emergency disaster drills were conducted on 3/19/2025.

LPA toured the facility with lead staff Liza. All exits were observed to be free and clear of obstruction. The LPA observed that the home was at a comfortable temperature for residents in care. The hot water was measured at 110.1 degrees Fahrenheit, which is within regulation. The bathrooms had grab bars and non-slip mats/flooring for resident use. There was sufficient lighting in all resident rooms, hallways, bathrooms, and common areas. Sufficient food supply of perishable and non-perishable food items.