Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required -1 Year visit, on 4/6/26 at approximately 9:40am, and met with Administrator Erika Molina who arrived from licensee's other licensed home. LPA observed a total of two (2) caregivers on duty. Facility's /Administrator Tilly Molina was contacted by staff, it was their day off, but the Administrator arrived to meet with the LPA.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for four(4) residents. 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, any resident room may be used for the bedridden clearance.

LPA reviewed six (6) resident files. All files were complete.

LPA reviewed five (5) staff files. All staff have required First Aid certification, and CPR certification. All staff have required criminal record clearance. All staff have annual training. Staff that handle and assist with medications have the required medication training.

LPA toured the facility with Administrator Tilly. All exits were free and clear of obstruction. All walkways were clear for resident's use, for visitor's, and for staff. The facility has a hard wired smoke alarm system which worked appropriately during the inspection. All fire extinguishers were serviced and tagged. Facility carbon monoxide detector (s) as required.