Facility Evaluation Report

On 10/31/25, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual inspection. LPA was met by staff one, Jerald Padunan - Assistant Administrator Designee (S1), and later by staff two, Rachel Tuazon - Administrator Designee (S2) and the purpose of the visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver approved for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (5) bedrooms, (3) full bathrooms, shaded back yard, front yard, laundry room and attached garage. Protective devices are in place, including non-slip mats and grab bars in all showers and the average water temperature is 113.6°F (degrees Fahrenheit) and all water sources provide water within title 22 regulations.

S1 accompanied LPA's tour of the inside and outside the facility during today's inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Doorways were free of obstructions. During LPA's tour, LPA observed the windows and screens to be in minor disrepair. Please see LIC809-D.