Facility Evaluation Report

Licensing Program Analysts (LPAs) Alviso and Contreras conducted a continued annual inspection, on 3/3/25 at approximately 2:25pm, and met with Administrator Eden

Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. Licensee is completing fire/evacuation/emergency drills quarterly as required.

Fire clearance is approved for four (4) non-ambulatory, of which one(1) may be bedridden. There were four (4) residents in care at the facility. Two (2) fire extinguishers were serviced and tagged as required. All exits were clear and free of obstructions. All exits had auditory alarms on the doors; All alarms were working properly during the inspection. Facility has a carbon monoxide detector that was working properly during the inspection.

LPA reviewed four (4) resident files, including medication storage and medication records.

LPAs reviewed four (4) staff files. All staff have required, criminal record clearance, first aid certification, and CPR certification

LPA is requesting the following documents be updated and submitted by 4/03/25.

LIC308 - Designation of Administrator Responsibility

LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required)

Infection Control Plan (ensure to review and update as needed/required)