Facility Evaluation Report

On 8/10/2026 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Administrator, Alma Guinto and stated the reason for their visit.

LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 11:15 AM and the following was noted:

The facility is a single-story building with four (4) bedrooms and two (2) bathrooms currently occupying two (2) residents. There is a designated staff room. The facility has an approved fire clearance for three (3) non-ambulatory residents and two (2) ambulatory residents.

Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 76°F. LPA observed a fire extinguisher to be located near the kitchen and dated 03/09/2026. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights to be located alongside the dining area. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents.

Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C)