Facility Evaluation Report

On 11/12/2021 at 10:20 AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct Pre-licensing required inspection. LPA met with facility manager, Liza Tagpis and supervisor Edwin Isip and explained the purpose of the visit. LPA called Ryan Busalachi one of the owners of the facility, per Ryan his brother Aaron Busalachi (Administrator) is not available due to medical reason. Ryan gave permission to LPA L. Ibo to discuss report to both Liza T. & Edwin Isip. Fire clearance is approved for 2 non-ambulatory on the first floor only, with approval total capacity of 6 ambulatory. The facility currently is licensed as a group home with 6 existing clients. However, facility is in the process of changing facility type and inspection is being conducted as a new Adult Residential Care Facility (ARF) facility.

LPA toured facility including but not limited to 6 clients' bedrooms, 1 staff room, 4.5 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Linens and hygiene supplies were observed inside a cabinet. Room temperature was maintained at 70 degrees F and hot water temperature was maintained at 119.3 degrees F. Smoke detectors and carbon monoxide were operational. Two fire extinguishers was last serviced on February 2021.

Client's file and staff files were reviewed.