Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced Annual Required Visit at 8:06 AM. LPA was met by Administrator Bituin and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old six (6) can be non-ambulatory, of which one (1) may be bedridden. Hospice waiver for six (6). LPA Gutierrez requested copies of Personnel Report (LIC 500), Resident Roster (LIC 9020) however, due to the facility currently not having any residents or staff, no copies were provided.

Currently the facility has no resident reside here. The facility is a single-story building located in a residential area with three (3) resident bedrooms, one (1) staff bedroom, one (1) staff bathroom, one (1) resident bathroom, kitchen, dining room, living room, front yard, backyard, and attached garage.

All bedrooms have the required linen and proper furniture. All toilets, hand wash basins, and bathtub/showers are fully stocked, clean, safe, sanitary and in good operation conditions. Bathrooms have the required grab bars and nonskid mats. All sharp knifes and cleaning supplies were locked and inaccessible to persons in care, in the laundry area and in a cabinet under the kitchen sink. LPA inspected the smoke detector and carbon monoxide, and they are all interconnected, operable and in compliance. The hot water measured between the 105-120 required temperature. LPA observed an appropriate food supply of two (2) days perishables and one-week (7 days) non-perishables. LPA observed the front and rear grounds landscaped with ramp leading to the exit and entrance; passageways and outdoor activity area are free of hazards, debris, and obstructions.

Due to no residents currently residing in the facility, there's no medication or resident/staff files to be reviewed during the annual inspection.

No deficiencies were observed or cited during today's inspection exit interview conducted with Administrator Emelita Bituin and a copy of the report was provided.