Facility Evaluation Report

Licensing Program Analysts (LPA) Alviso conducted a continued annual inspection, at about 9:00am on 4/14/25, and met with Manuel Ortega. The annual was started on 2/24/25, see LIC809.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, which includes one bedridden clearance (RM #6.) Fire extinguishers, two (3), were serviced and tagged as required. Facility has a required emergency disaster plan. Facility has a required infection control plan. Per review of emergency disaster drills, they are being conducted as required. Last drills conducted were 4/10/25 fire drill and 12/2/24 earthquake drill.

Currently there are five (5)residents in care. LPA reviewed five (5) resident files. All resident files were complete. LPA reviewed resident medication records.

LPA reviewed five (5) staff files. All staff had criminal record clearance. All staff had required training. All staff had first aid certification and CPR certification. Staff files were complete.

LPA is requesting the following documents be updated and submitted to CCL by 5/14//2025:

LIC308 - Designation of Administrator Responsibility

LIC610 - Emergency Disaster Plan-update if needed-submit if changes

Copy of current Administrator Certificate

Copy of updated Infection Control Plan- update if needed- submit if changes

Exit interview was conducted with Manuel Ortega, Administrator.