Facility Evaluation Report

On 06/25/25, at 3:15PM, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced case management visit, with a focus on staff to resident ratio. The facility is licensed to serve (6) residents ages 60 and above, of which six (6) may be diagnosed as non-ambulatory and one (1) resident diagnosed as Bedridden. The facility has an approved hospice waiver for six (6) residents. Currently the facility has four (4) residents in care.

LPA was met by staff two, Feri Sugiarto - Caregiver (S2), staff three, Esther Mariace - Caregiver (S3) and later by staff one, Rudolfo "Nino" Lozada - Assistant Administrator (S1), and the purpose of the visit was explained. LPA and S2 toured the facility.

During today's case management tour, LPA observed the physical plant in a clean and sanitary condition. LPA initially observed two (2) staff, resulting in a ratio of 1:2 (One staff : two residents). Within ten minutes of LPA's arrival, S1 has arrived to assist today's tour and effectively increasing staff ratio to 1:1.33 (One staff : One and one-third resident(s)). During today's tour LPA did not observe any deficiencies.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with staff one, Rudolfo "Nino" Lozada - Assistant Administrator (S1), and a copy of this report has been provided.