Facility Evaluation Report

Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Administrator Davilyn Mancilla and discussed the purpose of the visit. LPA and Administrator began the tour at the front entrance of the facility

A tour of the facility was conducted with the Administrator. The residence was set at 78 F temperature and free of passageway obstructions outside. Staff room bed was blocking door to enter the room that leads to a fire exit in the garage. LPA had to turn sideways to enter the room. Facility sketch lists staff room as a fire exit to the garage.

Resident rooms were clean. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the kitchen/Dining area. Cleaning supplies were locked in a cabinet in the garage. Smoke detectors and carbon monoxide detectors were checked and operating. Facility has a pull station fire alarm. Fire drill was last conducted 7/10/25.

Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed.

R1, R2 and R3 did not have Hospice Care Plans.

A copy of this report with plans of correction with appeal rights were provided to Administrator. Civil penalty was issued for fire clearance.