Routine inspection·May 2, 2026

On 05/02/2025 at 12:45pm, the Department conducted an unannounced annual required visit using the CARE Inspection Tool. The Department met with staff member Elizabeth Gomez (Adminstrator) and purpose of the visit was explained. The facility is licensed to serve residents age 60 and over, of which six (6) may be non-ambulatory, one (1) may be bedridden, and the facility has a hospice waiver for three (3). The facility currently has five (5) residents in care with (1) on hospice & (3) on receiving home health. The facility’s annual fees are current. The facility administrator’s certificate is Elizabeth Gomez #7017473740 valid 10/25/2024 - 10/24/2026. The facility has liability insurance with Certain Underwriters at Lloyd's (policy #ISCAH0100000189-00) with each occurrence at $1,000,000 and general aggregate at $3,000,000 valid from 11/02/2025 - 11/02/2026 The facility is a two-story residential home located in a residential neighborhood. The licensed facility space is located on the first floor and consists of three resident bedrooms, two bathrooms, a living room, dining room, kitchen, laundry area, activity room, garage/storage area with 2 refrigerator, and a backyard with a shaded area. On 05/02/2026, between the hours of 12:47pm - 1:00pm, the Department toured the physical plant and observed no bodies of water or firearms/ammunition on the premises. All resident rooms were checked and found to have beds and bedding in good condition, adequate lighting, and sufficient storage space for personal belongings. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly, the shower was free of mold and mildew, lighting was adequate, and sufficient toiletries were accessible to residents. The water temperature properly measured between 105°F -120°F with temperature testing at 117.1°F in kitchen and 105.8 in Bathroom 1. Report continues on LIC 809-C The Department observed the facility to be clean, orderly, and appropriately furnished. Storage areas for personal hygiene items, cleaning agents, toxins, and sharps were locked and inaccessible to residents. The kitchen was inspected and found to have an adequate supply of perishable and non-perishable food stored properly. Medications were centrally stored and properly locked. The First Aid kit was fully stocked. Fire extinguishers were fully charged and inspected on 11/01/2025. Smoke and carbon monoxide detectors were operable. The facility also has a landline phone avaliable for the resident s On 05/02/2026, between the hours of 1:05pm -2:35pm, the Department conducted a review of five (5) resident records, five (5) staff records, and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of the visit. The Department reviewed five (5) resident Medication Administration Records. During today’s visit, the Department did observe the deficiencies during the annual inspections. Based on observation, interview and records review, the facility did not have the following on file Resident 1 (R1) - TB Test & No LIC 601 & LIC 625 Resident 2 (R2) - No LIC 601, LIC 602, LIC 603, LIC 625, No Hospice Care Plan Resident 3 (R3) - No LIC 602, LIC 613, LIC 625 Resident 4 (R4) - No LIC 625 Resident 5 (R5) - No LIC 603, LIC 625 and No TB Test An exit interview was conducted, and a copy of this Facility Evaluation Report was provided with Appeal Rights to the Administrator Elizabeth Gomez