Facility Evaluation Report

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 08/28/2025. LPA was met by Staff #1 James Villanueva and Staff #2 Eduardo Librea and explained the purpose of the visit. S1 and S2 both assisted in the tour of the facility. Administrator Juanito Paguio arrived shortly after the facility tour. The facility is licensed to serve Developmentally Disabled Adults ages 18 to 59 years old and has a fire clearance approved for four (4) ambulatory and (1) one non-ambulatory clients. All clients receive services from Harbor Regional Center. LPA Madyun requested copies of Personnel Report (LIC 500), and Resident Roster (LIC 9020) copies were provided via LPAs cellphone camera.

Physical Plant/Environment Safety: A tour of the single-story facility began at approximately 8:45am that included residents’ rooms: one (1) private staff bedroom, four (4) semi-private bedrooms, two (2) bathrooms, living room, dining area, kitchen, backyard, garage/laundry room/storage space and indoor activity area. All residents’ bedrooms have the required furniture for privacy, comfort, and safety. LPA observed the carbon monoxide detector and inter-connected smoke detectors. Fire extinguisher located in corner of kitchen was fully charged and last inspected 7/24/25. First-aid kit was fully stocked and centrally stored locked in hallway cabinet. LPA observed the Infection Control Plan revised 8/25/25 and Emergency Disaster Plan revised 1/15/25.

Front Yard: Was clean and well maintained without any hazards.