Facility Evaluation Report

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Andrea Duran.

Facility is licensed for 4 residents and has a current census of 4. Water temperature was checked the common bathroom which read at 113.1 degrees Fahrenheit. Fire Extinguisher was serviced April 9, 2026 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order.

Andrea Duran Administrator's Certification expires 12/15/2027. Staff files were reviewed, are complete, and current. Resident files were reviewed, complete, and current. Facility provided a log for disaster drills that are conducted quarterly. First aid kit on site and complete. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications, LPA observed additional medication in an unlocked drawer in the staff desk located in the office.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. LPA spoke with Administrator regarding food supply.

Deficiency observed were cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing by May 15, 2026.

Exit interview conducted and a copy of this report LIC809, LIC809D, and appeal rights will be emailed to Administrator by end of business day 5/11/2026. LPA was having printing issues during the visit.