Facility Evaluation Report

On 02/17/26, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with staff (S1) Jelyn Pino. Licensee/Administrator (L1) Petro Crisostomo was called and stated unavailable to attend meeting. Licensee authorized staff to sign and receive report. LPA toured facility with S1. All four residents were present upon LPA arrival. One resident left for the doctor’s appointment shortly after LPA arrival. Resident observed in common area.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Staff medications were observed unlocked in staff bedroom. All residents and a sample of staff files were reviewed. Medications were checked and observed kept locked in the kitchen shelf. An adequate supply of perishable and non-perishable food was observed. Knives and sharps were observed locked in kitchen drawers . Freezer temperature was observed maintained at 0 and refrigerator maintained at 40 degrees F. Fire extinguisher was observed with a purchase date of: 03/05/25. Last fire drill completed on 01/1/26. First Aid kit observed with all required items. Cleaning solutions observed locked in laundry cabinet. A chemical bottle and staff medication bottle were observed unlocked in the garage. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. R3 bed was observed with full bed rails up. All bathrooms are observed with securely fastened grab bars and non-skid mats. Hot water temperature was tested 117.4 degrees F. in master bathroom and 112.6 degrees F in bathroom. Outside of facility toured and observed free of debris. Side gate was self-closing and self-latching. Outdoor seating observed is available for residents. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents’ MARS were reviewed, and medications were checked.