Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 5/13/26 at approximately 1:36pm, and met with Administrator Janine Sorenson..Licensee/Administrator arrived to meet with the LPA.

Facility has a fire clearance approval for 6 non-ambulatory of which 1 may be bedridden, in room #2 only. Fire extinguishers were charged as required. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) 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 quarterly drills are conducted as required; Last emergency drills were conducted on two shifts on 4/2/26, and on one shift on 4/4/26.

LPA reviewed six (6) resident files. Medications records were reviewed, and medications were found to be stored as required by regulation/HSC.

LPA reviewed five (5) staff files. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required. LPA reviewed required staff training, including medication training for those staff that assist resident's with medications.

The LPA toured the facility with the Administrator Janine. The hot water was measured at 114. degrees Fahrenheit. The exits were free and clear of all obstructions. All exits had auditory alarms on the doors. Facility had a sufficient food supply. All medications were locked up and inaccessible to residents in care. All medications were stored appropriately per regulations/law. All disinfectants/cleaners were locked up and inaccessible to residents in care.