Facility Evaluation Report

On 8/02/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection visit. LPA Medina introduced self and allowed entrance by Licensee/Administrator, Fe Tungpalan and discussed the purpose of the visit.

LPA Medina observed COVID protocols in place, visitor/temperature log, masks, gloves, and disinfection station at the front entrance. Facility has one entry and exit point. Social distancing is maintained in the common areas. Facility has hand washing and COVID-19 posters signs throughout facility. All facility staff observed to be wearing face masks.

LPA Medina observed residents to be watching television in the living room, having lunch, and some resting. Resident bedrooms toured, all beds have a minimum of 6 feet between them. Bathrooms have hand soap and paper towels available. Facility has a 2-day supply of perishable food and 7-day supply of non-perishable food available. Medications observed to be locked and secured in cabinet in dining room. Facility has a supply of Personal Protective Equipment (PPE) on hand: gowns, face shield, gloves, masks, head covers, and shoe covers.

Fire extinguisher present with a service date of 7/22/22. Facility is equipped with a pull station and auditory alarms. Carbon monoxide and smoke detectors observed to be operational during today's inspection.

Exit interview was conducted and a copy of this report was provided for facility records.