Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Pandapotan Pardosi and oJcelyn Habaradas, Care Staff and explained the purpose of the visit. At 10:30am, Administrator Jennifer Manabat Leon arrived and assisted LPA with the inspection. The facility is approved to serve elderly residents age range 60 and over, (6) non ambulatory of which (3) may be bedridden. Facility is approved for (6) hospice waiver. 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 observed. The facility has Infection prevention and control plan, process, procedures and training plan. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency and disaster plan was completed and up to date.

Operational Requirements: Fire Drill is conducted quarterly and the last drill was conducted on 07/09/2025. Facility has working signal systems in exit points. Liability insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires on 06/01/2026. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the residents with special needs were observed.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (1) staff bedroom, (2) bathrooms, living room with covered fireplace, kitchen, dining area, laundry area in the attached garage and front yard with shaded patio area. There are currently (6) residents, of which (2) are under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed cameras outside the property. Front yard was inspected and has a shaded area and sitting area. There is (1) fire extinguisher in the facility which was serviced on 02/25/2025. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. @ 10:35am, readings were 110.4 deg. F in bathroom #1 and 111.9 deg F in bathroom #2. *****REPORT CONTINUED ON LIC809-C*****