Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced One (1) Year Required visit to this facility. LPA met with Administrator Mary Jane Montiano and explained the purpose of the visit. The facility is fire cleared for six (6) ambulatory residents.

A tour of the physical plant was conducted at 12:25 PM and the following was noted:

The front main door is the only entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted approved Mitigation and Infection Plan.

The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage

Facility has three (3) client bedrooms; all shared rooms. One (1) additional bedroom is designated for staff use. The facility has three (3) bathrooms. One (1) bathroom is designated for staff use. There is no body of water in the facility. Backyard has a tool shed and shaded area for residents.

Bedrooms were toured and observed to be clean and appropriately furnished. There are sufficient supplies of linen and towels in the linen cabinet.