Facility Evaluation Report

On this day, April 13, 2023, at 11:45 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Mildred Gozales, and informed the reason for visit. LPA also met with other staff, Gemma Baluyut. Annie Batangoso, administrator, and Lilibeth Lopez, back-up administrator, arrived after several minutes.

LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining and living areas. Only 1 resident observed during inspection and the other 2 were at day program. Facility has sufficient perishable and non-perishable foods. Fire extinguisher was observed fully charge with tag showed serviced October 4, 2022. Facility has carbon monoxide and smoke detector that were tested and observed functional. Hot water temperature in the common bathroom was tested and measured at 105.1 degrees Fahrenheit.

LPA reviewed 3 residents and 5 staff files, and interviewed 1 resident and 2 staff. Medications were checked and compared against records. Residents' cash resources match with records.

LPA received the following updated documents on this same day:

1. LIC308 Designation of Facility Responsibility

2. LIC400 Affidavit Regarding Client/Resident Cash Resources

4. LIC610D Emergency Disaster Plan (9 pages)

No citation issued during today's inspection.

Exit interview conducted and copy of report provided.