Facility Evaluation Report

On 01/28/2025 at 1:28 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct an unannounced Required Annual Inspection. LPA was greeted by caregiver Dulce Villeros who granted access. Dulce asked LPA to sign in and they sent a text message to the administrator, Jojo Cajayon letting them know LPA was at the facility. Staff #2 (S2) at the facility contacted administrator via telephone and LPA explained the reason for the visit. The administrator could not meet LPA at the facility for todays visit, and designated Dulce to sign today's report. The inspection tool was used to conduct this visit.

At approximately 1:35 p.m. LPA began a physical plant tour of the facility and the following was observed:

Dining / Living Area: LPA observed required postings by the facility entrance. LPA observed two residents watching tv in the living area. The dining and living area were clean and clear of clutter. Furniture appeared clean and in good repair. Dining table was clean, clear of clutter and sits the capacity of the facility. The fire extinguisher was observed by the dining table fully charged last serviced on 05/15/2024. In the hallway LPA observed the thermostat at a comfortable temperature of 77°F.

Kitchen: LPA observed the kitchen to be clean and clear of clutter. Cleaning chemicals are locked under the sink. Knives and sharps are kept locked in a kitchen drawer inaccessible to residents. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food; properly stored. LPA observed a small refrigerator locked and used for storing medication requiring refrigeration and a second staff refrigerator.

LPA observed smoke detectors through out the facility that are interconnected and dual carbon monoxide detectors. LPA observed caregiver test the dual smoke/carbon detector at 2:18 p.m. and it was observed to be functioning properly. (Continue to LIC809-C)