Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conducted a Required -1 Year visit, on 4/24/2025, at approximately 9:25am, and met with Licensee/Administrator Ami Kumar, and Janine Sorenson, facility Administrator.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden.

LPA reviewed six (6) resident files. LPA reviewed six (6) staff files. LPA reviewed staff training. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required.

The LPA toured the facility with Administrator Janine Sorenson. Medications were centrally stored, locked and inaccessible to residents in care, and inaccessible to staff not trained to assist residents' with medications. The hot water was checked at 120. degrees Fahrenheit, which is within regulation. Fire extinguisher, 2 of 2, were serviced and tagged as required. All exits were free and clear of obstructions. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins/cleaners are stored in locked cabinets. All exit alarms were on exit doors and working properly during the inspection.

All bathrooms had grab bars, and non-slip mats/flooring for bathing as needed. Required postings were up and visible. LPA observed a sufficient supply of perishable and non-perishable food.