Facility Evaluation Report

On 7/30/2026, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Administrator Jacklyn Becerra.

LPA conducted facility tour with Administrator Jacklyn Becerra. All pathways, entrances and exits were clear from obstructions. The tour started in kitchen, continued to dining room, living room and resident rooms. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Sharps are locked in kitchen cabinet. Facility Laundry room is connected to Kitchen. Laundry room observed locked with cleaning supplies and chemicals. Office area observed with back up supplies and cleaning supplies; Office is kept locked when no one is present. Dining room and Living room observed with sufficient seating and activities for residents. Facility has five residents at this time. LPA toured several bedrooms which were observed to be furnished with required furniture and adequate lighting. Four residents observed with full bed rails. Bathrooms were properly equipped with non-slip mats and grab bars. Fire extinguishers were last serviced on 6/1/2026 and was fully charged. Linen supply is kept in the hallway closet. Carbon monoxide and smoke alarm detectors installed and operational. LPA observed sufficient seating under covered patio area in the back of the facility. Side gate was self-closing and self-latching. Medications are kept in locked cabinets in the hallway. Last fire drill was conducted on 5/06/2024. Resident's records contained signed Admission Agreement, Personal Rights, and Emergency Identifications forms. 3 out of the 5 residents had current Physician's Reports. During medication audit LPA observed 2 out of 5 residents that had a missed dose of medication. 2 out of 5 residents PRN medication was not logged or was logged without the required information. Facility failed to have appraisal needs and service plan for residents and Hospice Care Plan did not have facility duties outlined for providing care to residents. Staff files were reviewed for good health. It was verified that current staff on duty is CPR certified.