Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met

with Virgilio (Gil) Agas, administrator, who assisted with visit. The facility is licensed to serve the elderly who are 60 years and older. It has 25 hospice wavier approved. Its capacity is 200 residents including 149 non-ambulatory, of which 15 may be bedridden. Rooms 101-119 are approved for bedridden. Annual fees are current. Administrator certificate is current and the expiration date is 7/14/2023.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food

supply was reviewed, medications/staff's files/residents' files were reviewed, and staff and residents were interviewed.

The facility is located in a residential neighborhood. It is three-story, stucco structure with 91 bedrooms, 91 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, a laundry room, a coin laundry room, a janitor storage room, an activity room, a dining room and two elevators. There is a covered patio area on the premises. The resident bedrooms are spacious and will easily accommodate the resident's furnishings. Passageways, walkways, stairs and patios are free from obstructions. The entrance and side areas are free of hazards and debris.

A physical tour was conducted. LPA toured Room# 110, 212, 219, 220, 242, 316, 320 and 331.

Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean,

operable, with the required grab bars and non-skid materials in the shower. Hot water temperature

was in a range of 105.3 to 116.5 degrees Fahrenheit which was within Title 22 Regulation