Facility Evaluation Report

On 9/5/2025 at 10:55AM, Licensing Program Analysts (LPAs) Andrew Christy and Luisa Fontanilla arrived unannounced to conduct a Required - 1 Year inspection. LPAs met with caregiver, Amanaki Pomee, and explained the purpose of the visit. Administrator, Felomena Tabones, arrived 45 minutes later. Facility is currently at capacity with 6 residents.

LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed to be operational. Temperature inside facility is comfortable for residents and measured to 71 degrees Fahrenheit. Water temperature in the kitchen was measured to 113.9 degrees Fahrenheit. Fire extinguisher was observed to be full and last serviced on 09/10/2024. One week of nonperishable and 2-day of perishable food supplies were available. LPAs observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete.

LPAs reviewed 5 residents and 4 staff files, and all staff files found to be complete. Emergency disaster plan was last reviewed 10/24/2024.