Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year visit, on 5/13/26 at approximately 9:40am, and met with back-up Administrator, Janine Sorenson. Licensee/Administrator Ami Kumar arrived to meet with the LPA.

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. Emergency disaster quarterly drills are being conducted as required; Last drills were conducted, two shifts on 4/9/26 and one shift on 4/10 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.

LPA toured the facility with the Administrator Janine. Hot water was measured at 114.6 degrees Fahrenheit. All exits were free and clear of obstructions. The exit doors had auditory alarms on them. The fire extinguishers were charged as required. The smoke alarms are hard wired and were all working during the inspection. The carbon monoxide detector was working during the inspection.