Facility Evaluation Report
On 5/20/2025 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived at the facility for an unannounced annual visit. LPAs contacted Licensee, Kathy Lewis who stated staff would be out. Administrator, Tami Leyva arrived some time later. LPAs introduced self, explained reason for visit and were permitted entry into the facility. Residents not present during visit.
LPA toured the facility inside and out. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher was purchased on 1/17/25 and observed to be charged. Last fire drill on conducted in 4/15/25. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps and medications were located in locked cabinets and cupboards. LPA observed sufficient seating under covered patio areas.
The following issues were observed during todays visit: Screen observed broken in bedroom #1 and in need of repair. Carpet in bedroom #3 closet observed torn/worn and in need of repair. Bedroom #3 door in need of transition. Door and trim observed in need of repair in hallway bathroom. Moss observed on back patio stone in need of removal. Wall on back patio near dryer vent in need of cleaning. Touch up paint needed on maintenance room door. Large garage door in need of weather stripping.
LPAs requested the following documents to be submitted to CCL by 6/6/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.
Exit interview completed with Administrator, Tami. A copy of this report, deficiencies, TVs and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction