Facility Evaluation Report

On 10/26/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit.

introduce self, stated the purpose of the visit and met Eddiemer Sison, Designated Representative. All four

residents were present during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. The temperature is maintained for refrigerator at 37 degrees F and freezer at 0 degrees F. Fire extinguisher was observed with a service date of: 09/26/22. Fire drill last completed:10/02/23. Medications observed kept locked in kitchen shelf. MARs were reviewed. Cleaning supplies and chemicals stored and locked in garage cabinet. All bedrooms were observed to have the required furnishings and with adequate lightening.

The bathrooms were toured. Bathrooms were observed operational during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 147.7 degrees F in the bathroom 1 and range between 148.6 and 147.8 degrees F in master bathroom. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching.

Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ files were reviewed to have all the required documents. Staffs’ files were also reviewed. Staff files were observed to have current First Aid/CPR, fingerprinted clear and associated to the facility.