Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection, on 2/24/26 at approximately 9:45am, and met with caregivers Dina Camilon and Estelita Cabardo. Staff contacted Administrator Eden Relota, and notified them the LPA was at the facility. The Administrator arrived to meet with the LPA for the annual inspection.

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. Per file review, last fire drills were completed on 1/20/26, Fire drill, and 12/10/25, Earthquake drill. 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 three (3) residents in care at the facility. Two (2) fire extinguishers were serviced and tagged as required. Facility has a carbon monoxide detector that was working properly during the inspection. The smoke alarms are hard wired, and worked appropriately during the inspection check.

LPA reviewed three (3) resident files, including medication records and medication storage.

LPA reviewed three (3) staff files. All staff have criminal record clearance as required. LPA reviewed staff training. Staff had required first aid and CPR certification.

Hot water was measured at 117.5 degrees Fahrenheit. All exits were clear and free of obstructions. All exits had auditory alarms on the doors; All alarms were working properly during the inspection.