Facility Evaluation Report

Licensing Program Analysts (LPA) Alviso conducted a Required- 1 Year visit, on 6/22/26 at approximately 9:45am, and met with Administrator Bana Solomon. There are six (6) residents in care; One resident is on hospice care. LPA observed two (2) caregivers on duty during the inspection.

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. All smoke alarms are hard wired and working properly, including the carbon monoxide detector. All exits were observed to be clear and unobstructed.

Facility has a 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. The emergency disaster drills are being conducted as required, per file review.

LPA reviewed six (6) resident records, including medication records; LPA observed the storage of all medications.

LPA reviewed five (5) staff files, including training. All staff have DOJ criminal record clearance as required. All staff have required training. All staff have required first aid certification and CPR certification.

LPA toured the home with Administrator Bana Solomon. The facility was observed to be at a comfortable temperature. The home has central heating and air conditioning for use as needed. The facility has an in-ground stand-by generator for use in an emergency.