Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 05/19/26 at approximately 3:00pm, and met with Lorena Madriga-Back-up Administrator. Administrator Mera Shaughnessey arrived to meet with the LPA. There currently are six (6) residents in care. LPA observed two caregivers on duty.

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. 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. Emergency disaster drills are being conducted as required. Last emergency disaster drill. was conducted on 4/5/26, wild fire drill, and the previous one was conducted on 1/10/26, power outage drill.

LPA reviewed six (6) resident files. All medication records were complete and medications were stored and locked up as required.

LPA reviewed five (5) staff files. Staff reviewed all had current required first aid certification and CPR certification. All staff had required criminal record clearance. LPA reviewed staff annual training, and medication training for those staff that assist residents' with medications.

The LPA toured the home with the Administrator Mera Shaughnessey. The exits were all free and clear of obstructions. The fire extinguishers were serviced and tagged as required. All medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care.