Facility Evaluation Report

Licensing Program Analyst (LPA)s Vaid and Mallett conducted an unannounced annual inspection visit. LPAs met Ronie Culala-caregiver who allowed entry into the facility, Ralph Estanislao, Administrator notified. LPA explained the purpose of the visit. The facility has a capacity of six (6) to serve residents from age 60 and above which may have six (6) non-ambulatory and three (3) hospice waivers. Two (2) residents are on hospice. Administrator certificate is current, and expiration date is 03/17/2027.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

The facility is a single-story house located in a residential neighborhood consists of three (3) shared bedrooms, two (2) bathrooms, open living room, dining room next to the kitchen, laundry room, outdoor patio and a storage shed in the backyard. No garage. Staff area next to laundry room, inaccessible to residents.

Residents' bedrooms have dresser, chair and closet space available. Adequate linen and personal hygiene supply are observed. Adequate linen and personal hygiene supplies. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. The kitchen is clean and has maintained the required food for two (2) days perishable and seven (7) days non- perishable. Appliances are in working condition. Hot water temperature was in a range of 105-120 degrees Fahrenheit which was within Title 22 Regulation guidelines.