Facility Evaluation Report

On 06/16/2025 at 1:30 PM, Licensing Program Analyst (LPA) Triel Ellen LIndstrom arrived at the facility unannounced to conduct a required annual inspection and was greeted by Licensee/Administrator Edith Rodriguez (#7013119740). The LPA identified herself and explained the purpose of the visit. Licensee accompanied the LPA on a tour of the physical plant, including inside and outside areas, to ensure that there were no health and safety hazards.

This facility is a residential home with four bedrooms. At the time of this site visit, the census was four residents. All four residents are non-ambulatory, although one resident can walk around with a walker. A Caregiver arrived at the facility at 1:40 PM. The second administrator of the facility Samuel Rodriguez (#6067581740) arrived at the facility at 2:30 PM.

The LPA entered the facility and observed the required postings on a bulletin board to the right of the entry door, including personal rights, mandated reporting, emergency plan, ombudsman information, facility license, and the administrators' certificates.

The LPA toured the living/dining room and observed five recliners, a television, and several side tables. There were two residents sitting in recliners in the living room; one was asleep. LPA also observed a dining table with four chairs.The fire extinguisher hung from the wall between the living room and kitchen and was last serviced in October 2024 by ARF Fire Extinguisher Co.of Modesto.