Facility Evaluation Report

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today and met with Harley Almira and Josephina Facultad, Caregivers, and the reason for the visit was explained. Joy Alipio, Administrator, was informed telephonically regarding today’s visit and arrived thereafter.

The facility is licensed to serve (6) adults age 60 and over; (2) ambulatory and (2) non-ambulatory (room #2 and #3 cleared for 2 non-ambulatory and room #4 for ambulatory). Facility also has an approved Hospice waiver for (1) resident. There are currently (4) residents living in the facility. The facility is operating within the scope of its license.

The facility is a single-story home located in a residential neighborhood of Long Beach and consists of the following: four (4) resident bedrooms, (3) bathrooms, living room with workspace for staff, kitchen, dining area, laundry area, an outside shaded seating area, and a detached garage.

The following was observed during today’s visit:

· Facility is clean and walkways, ramps and exits are free of debris and obstructions. Furniture throughout the facility is in good repair. Sufficient seating is available in the living room and dining area. Bedrooms have the required furniture such as beds, dressers, lamps, and chairs. The rooms have ample closet space. Beds have mattress pads and clean bedding.

· Kitchen appliances are clean and were observed to be working properly. The home has sufficient 2-day perishable and 7-day non-perishable supply of food. Food is properly stored and kept within expiration limits. Knives and other sharps are locked and inaccessible to residents in care. Cleaning supplies and other toxins are also kept locked.