Facility Evaluation Report

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and inspection of the facility. Upon arrival LPA met with John Lingad and explained the reason for the visit. LPA spoke with Administrator - Josefina Lacsamana over the telephone. At approximately 12:10pm Administrator came to the facility and met LPA. The facility is licensed to serve six (6) non-ambulatory residents with an approved waiver for three (3) hospice residents and one (1) bedridden resident.

At 10:45am, with the assistance of Staff, LPA took a tour of the physical plant. The facility is a one story structure with six (6) bedrooms, three (3) bathrooms, kitchen, dining area, living room and office area. Required postings were observed in the entry area. The smoke alarms/carbon monoxide detectors are battery operated. At 11:15 am smoke/carbon monoxide detectors were tested and observed to be functional. There are four fire extinguishers, located in the kitchen, dining room, living room and in the hallway next to bedroom #5. All fire extinguishers were observed to be full and serviced together on 1/23/2025. The auditory alarms on all exit doors were functional at the time of the visit. Facility conducts quarterly fire and earthquake drills. The last fire drill was conducted on 06/15/2025 and earthquake drill was conduced on 08/15/2025.

Common Areas: These included the living room and dining room. The common areas were properly furnished with tables and chairs for the number of residents. A piano and keyboard were seen in the dining room and a television and cabinets with games, karaoke machine in the living room. There is a linen closet in the hallway, near the bedrooms.

Laundry Room: The laundry room is accessed through a locked door from the living room. LPA observed chemicals and detergents stored in cabinets, in the locked laundry room.