Facility Evaluation Report

On April 30, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a visit regarding POCs.

LPA observed 2 residents at the facility (R1 & R2) with 2 staff. While at the facility LPA observed when owner Howard Fergerson arrived at the facility to say good bye to R1. LPA observed facility to be clean, odor free, and clutter free.

Lady is working on the proper Administrator Certification and is in constant contact with LPA. Lady has reached out to the Dept handling the certification testing and is waiting for a follow-up. Lady will provide a plan for scheduling staff training by May 8, 2026. Verification of oxygen training will be provided to LPA by May 5, 2026.

During the visit LPA observed the following corrections:

Glue trap has been moved and is no longer with clean dishes

Knives are in lock container under the sink

R2's centrally stored medication log was current and up to date

Resident's P&I is balanced and matches logs

Licensee purchased a surety bond for facility

LPA reviewed facility's disaster drill log

Letters of cleared POCs were generated, printed, and provided to Caregiver Lady Villanueva.

Exit interview was conducted and a copy of this report LIC809 was provided to Caregiver Lady Villanueva.