Facility Evaluation Report

On 05/15/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual

inspection visit to this facility. LPA met with Administrator, Mary Jane Bagaipo, and explained the purpose of the visit. LPA was granted entry to the facility. The facility is licensed to serve four (4) non-ambulatory and two (2) ambulatory residents ages 60 and above. Currently there are four (4) residents in care.

The facility is a single-story structure located in a residential neighborhood and consists of the following: three (3) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, dining room and a dining area, office space, a garage with laundry space and indoor/outdoor activity area and backyard.

LPA Gonzalez toured the physical plant inside and out. There were no bodies of water or

obstructions on the premises. All rooms were inspected, bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Bathrooms were operational and observed to be within Title 22 regulations. The facility was observed to be appropriately furnished at the time of visit. A comfortable temperature was maintained in the facility.

The kitchen was inspected and observed to be within Title 22 regulations. Sufficient perishable and

non-perishable food supply was maintained adequately. All sharps, toxins, cleaning solutions, and hazardous items, were securely locked and inaccessible to residents. A review of Medication Administration Records was maintained in order and accurate.