Facility Evaluation Report

On 12/15/2022 around 09:00 AM Licensing Program Analysts (LPA) Jose Calderon conducted an announced visit for Olive Tree Home Facility and met face to face visit with Administrator Rommel Dungca for purpose of a pre-licensing evaluation. The requested capacity is for 18 non-ambulatory Adult Resident Facility.

Facility is a 10 bedroom, 3 bathrooms, one-story house. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a backyard with a covered patio for shade. The patio contained 2 tables and 10 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA Calderon did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility . Residents Bedrooms : All 10 Bedrooms are for ambulatory/non-ambulatory clients. Bedroom’s #1 and #2 and #3 and #4, #5, #6, #7, #8, #9 and #10 has one bed each, one chair, one-night stand, one lamp, one dresser. Bathroom 3: Have a working toilet, wash basins, and walk-in shower, grab bars. LPA Calderon observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu: The telephone system is a land line and operable. Emergency Disaster Plan and "See something, say something Let Us Know" was noted. Fire Extinguisher 1 mounted on the wall in hallway next to the kitchen.