Facility Evaluation Report

On 10/15/2024 at approximately 10:00 am, Licensing Program Analysts (LPAs) Angelica Segovia and Gina Saucedo met with caregiver Gemma Wanawan for a One (1) Year Required, Unannounced visit for this facility. LPA explained the reason for the visit.

LPA asked for census, staff, and resident files…. 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 five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents. Hospice waiver for one (1) resident.

Required postings such as Personal Rights and Ombudsman were located at the main entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

Both living and dining rooms are neat, clean, and organized. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. Fire extinguisher located in the kitchen and last inspected on 08/29/24. Additional required postings were observed aside the kitchen such as: Yes poster, Fire Drill and Disaster Plan.

The kitchen observed to be fully stocked with two (2) days perishable and seven (7) days non-perishable food. Kitchen observed to be clean and inaccessible to pests. Knives and sharps observed to be locked in a kitchen drawer and inaccessible to residents. Cleaning solutions are kept locked in a cabinet under the sink. Stove observed to be working and in proper condition.