Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year inspection, at about 1:55pm on 3/10/26, and met with Administrator Manuel Ortega. LPA observed three care staff, S3, S4,and S5, on duty upon their arrival; The staff contacted the Administrator Manuel to notify them of the LPA's arrival. Currently there are six (6)residents in care.

Facility has a dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, of which one may be bedridden (RM #6.) Facility has a required infection control plan. Fire extinguishers, two (3), were serviced and tagged as required. Facility has a required emergency disaster plan. .

LPA reviewed six (6) resident files. All files were complete, including medication records. All medications were locked up and centrally stored, as required. LPA reviewed four (4) staff files. All staff had criminal record clearance as required. All staff have first aid certification and CPR certification.

Facility had sufficient lighting in bathrooms, resident rooms, hallways, and all common areas for residents in care. The home was at a comfortable temperature during the inspection. The food supply was observed to be sufficient, in perishables and non-perishables. The facility was clean and orderly. Bathrooms had grab bars, and non-slip mats/flooring in showers for resident use. Facility had sufficient furnishings for residents' use. Facility hot water was measured at 114.8 degrees Fahrenheit. Backyard was clean and orderly, with patio/yard furnishing for resident use as wanted.