Facility Evaluation Report

On 06/15/2026, Licensing Program Analysts (LPAs) Arielle Pascua and Sulma Lopez arrived unannounced at the facility at 9:51am. LPAs met with Staff 1, Terry Salcido and explained the purpose of the visit and requested Staff 1 to notify Facility Designated Administrator (FDA) of their arrival. Shortly after, FDA Jaime Rolando Andrade arrived at the facility. The purpose of the visit was to conduct the annual visit. Current census was 5. A brief interview with FDA Andrade was conducted.

The facility serves up to 6 residents 60 and older. There are no dementia plan or hospice waivers on file.

LPAs Pascua and Lopez reviewed 7 staff files and 5 resident files. All files were complete and up to date. FDA Andrade has an active administrator certificate #607797740 and expires on 08/07/2027.

LPA Pascua reviewed an eviction notice at the time of the visit and deemed that the eviction notice was legal at this time.

LPAs Pascua and Lopez reviewed medication administration records. It was discovered that 1 out of 5 Resident's MAR indicated that one of their medications were administered and not signed off by care staff. First aid kit was present and contained all the required components. LPAs spoke with FDA Andrade regarding best practices to ensure the MARs have been signed upon administration.

A tour of the facility was conducted. LPAs reviewed the kitchen and observed sufficient amount of food in the facility.

LPAs reviewed resident rooms and restrooms. Furnishings and grab bars were in good repair. Water temperature was adequate at 110 degrees in both restrooms.

The fire extinguisher was serviced 06/10/26 by Jorgenson Co. LPAs observed the carbon monoxide and smoke detectors was working properly.