Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required 1 Year inspection at the facility today. The LPA met with administrator Rose Lopez and explained the reason for the inspection.

RECORDS: A review of facility files was initiated. Facility records are stored in the locked office upstairs. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 02/01/26). The LPA advised the administrator that disaster drill needed to be conducted for all shifts. The LPA obtained Client Roster, Staff Roster and Insurance liability. The LPA reviewed five(5) out of six (6) resident files and four (4) out of four (4) staff files. All records were complete with pre-admission appraisals, needs and services plans, physician reports, admission agreements, and emergency contact information. However one residents appraisal needs and services plan is one month overdue. Otherwise, all resident and staff records were complete and current.

The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Knives are locked in a drawer and cleaning supplies are stored inaccessible in a locked cabinet and in the locked garage. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The LPA observed the stove knobs without covers.

COMMON AREAS: The living room, family room and dining room areas were furnished appropriately and furnishings were in good condition. The facility maintained a comfortable temperature. Smoke detectors and carbon monoxide detector were tested and functioned properly. The fire extinguisher was fully charged and last serviced 2/06/2026. Report will continue on LIC809-C, 2nd page.