Facility Evaluation Report

On 2/20/2025 at approximately 10:00 AM, Licensing Program Analysts (LPAs), Angelica Segovia and Leslie Ngo-Castaneda conducted an unannounced annual visit to the facility. LPAs were greeted by Administrator Chrysel Dela Cruz. LPAs stated the reason for their visit.

LPAs asked for census, Staff/Resident Roster, and Insurance. LPAs conducted a physical plant tour at approximately 11:00 AM and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. There is one (1) designated staff room. The facility has approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for three (3). Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Required postings such as See/Say Something, Facility Sketch, and Facility License are located immediately upon entrance.

Common areas: Living room and dining room observed to be neat, clean, and organized. Both rooms observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. Fire extinguishe r located in the kitchen and dated 04/24/24. Fireplace: Observed to be covered and inaccessible to residents. Working telephone observed.

Kitchen: Kitchen observed to be clean and inaccessible to pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. Knives and sharps observed to be locked in kitchen drawer. Toxins and cleaning solutions locked underneath kitchen sink. Kitchen appliances observed to be working and in proper condition. (continued on LIC 809-C)