Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Nelia Macasinag, Caregiver and explained the purpose of the visit. At 10:50am, administrator, Elna Villaflor arrived and and assisted LPA with the inspection. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs. Bathroom has hygiene items such as paper towel, hand soap and toilet paper.

Operational Requirements: A fire clearance is in place. Plan of operation and training logs were reviewed. The facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 04/02/2026. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (5) bedrooms, (4) of which are resident bedrooms, (1) staff bedroom, (2) bathrooms, living room, formal dining room, family room with fireplace, dining area for residents, kitchen, laundry area, attached garage, and backyard with patio area. LPA observed a stand alone shed converted into a sleeping room for staff. There are currently (3) residents, 60 years and older residing in the facility, (1) is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a bed, linen, light, chair and sufficient closet space. Backyard was inspected. All outdoor and indoor passageways are kept free of obstruction. There are (2) fire extinguishers in the facility purchased on 12/21/2025. There are smoke detectors located in each bedroom and a carbon monoxide detector located in the hallway. There are no firearms or weapons stored at the facility. The hot water temperature was measured between the required range of 105-120 degrees F. *****REPORT CONTINUED ON LIC809-C*****