Facility Evaluation Report

At 11:15 am on this day, October 13, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Maria Theresa "Tek" Ordiniza, assistant administrator, and informed the reason for visit. LPA also met with other staff, Marieta Balilo. There

were 2 residents present when LPA arrived.

Facility has Infection Control Plan that was submitted and received by LPA on June 30, 2022.

LPA inspected the facility inside and out including but not limited to bedrooms, bathroom, kitchen, dining and living areas, front, garage, front, side and backyard. Facility has supplies of food of 2 days of perishables and 7 days non-perishable. Fire extinguisher was observed fully charge with tag showed serviced March 22, 2023. Facility has carbon monoxide and smoke detectors that were tested and observed functional. Hot water temperature in the common bathroom was tested and measured at 108.4 degrees Fahrenheit. Facility conducts disaster drills monthly, and records showed last conducted October 3, 2023. Central storage for medications and storage for cleaning supplies and sharps were observed locked.

LPA reviewed 5 residents and 5 staff files, and interviewed 2 residents and 2 staff. Medications were inspected and compared with doctor's orders and records. P&I/cash resource checked and compared with ledger.