Facility Evaluation Report

On 06/11/2026 at 1:15 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Kristine Bergonio, and explained the purpose of the visit. Ms. Bergonio phoned Licenses/Administrator, Mylin Villanueva, to inform. Ms. Villanueva was not available and gave Ms. Bergonio authorization to sign the report. The facility’s fire clearance was approved for six (6) non-ambulatory residents. Hospice waiver approved for six (6) residents. Administrator certificate #7030023740 expires 01/11/2027.

LPA toured facility with Kristine including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 5 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 63 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.