Facility Evaluation Report

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Isagani Datinguino, Caregiver who was informed of the purpose of the visit. Administrators Xiomara Valencia arrived thereafter.

The facility’s fire clearance is approved for six (6) residents age 60 and over, including up to six (6) non-ambulatory residents, of whom one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents.

At the time of inspection, there were six (6) residents in care.

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Required “Oxygen in Use” signage was posted in visible locations throughout the facility in accordance with safety requirements.

The facility is located in a residential neighborhood and is a single-story home consisting of five (5) resident bedrooms, three (3) bathrooms (one of which is designated as a guest bathroom), a living room, family room, kitchen, dining area, and a caregiver corridor near the kitchen and attached garage. An additional caregiver corridor is located near the resident restroom. All bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Bathrooms were observed to be clean and equipped with required grab bars in the showers and near the toilets, as well as non-skid mats. Hot water temperatures measured 116.9°F in Restroom (1) (guest restroom), 109.9°F in Restroom (2) (resident restroom), and 114.3°F in the third bathroom. (continued on 809C)