Facility Evaluation Report

On 02/24/26 at 2:18PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a required annual inspection. LPA explained the purpose of the visit with administrator (ADM). LPA observed no residents living at the facility. ADM has a current administrator certificate # 7007386740 which expires 02/07/27.

At 2:25PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, resident and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 72 deg F. Hot water temperature was measured at 114 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged and last inspected on 09/09/25. LPA reviewed 2 staff files.

Updated copies of the following documents were collected for facility file:

 LIC308- Designation of Facility Responsibility

 LIC610E- Emergency/Disaster Plan including infection control plans

Exit interview conducted and a copy of this report provided .