Facility Evaluation Report

On 1/12/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Administrator designee Estelita Agpao, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the wall of dining and living room areas and requested staff and residents’ rosters for review.

The inspection tool was used to complete the visit.

At 12:10pm LPA, with the help of the Administrator designee, began a physical plant tour of the facility and the following was observed: This is a single-story building with six (6) bedrooms, of which five (5) rooms designated for residents’ use. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for five (5) Non-ambulatory residents, bedridden resident for room #2, and a Hospice waiver for one (1) resident.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet, however, at the time of the visit the knife/sharps cabinet was unlocked. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers located in the kitchen and next to the entrance area. The fire extinguishers were last serviced on 5/16/2025. Dish soap and other chemicals observed to be stored under the sink, however, at the time of the visit LPA observed the cabinet to be unlocked and available to residents in care.