Facility Evaluation Report

At approximately 8:35 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a 1-Year Required Visit. Administrator, Angelica Martinez, arrived to facility at approximately 8:55 AM. The facility is a two (2) story house with staff rooms and one (1) bedroom for an ambulatory resident on the upper level. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident for a total capacity of six (6) residents. Facility has an approved hospice waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) Residents in care. At approximately 9:00 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 9:05 AM, LPA toured the facility. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 10/7/2025. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. Per regulations the facility is required to conduct fire and emergency drills quarterly. The facility is not keeping a Disaster Drill log. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C...