Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year Visit on

05/18/2024. LPA was met by Administrators Rey Tabayoyong and Rosalie Tabayoyong and explained the purpose of the visit. The facility is licensed to serve five (5) residents over the age of 60, of which five (5) may be non-ambulatory and has a hospice waiver approved for one (1).

LPA OBSERVATIONS: The facility is a two-story dwelling located on a residential street and consists of three (3) resident bedrooms, one (1) bathroom, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to one (1) out of one (1) resident in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to one (1) out of one (1) resident in care. Kitchen sink water temperature was measured at 116.5 degrees F. Kitchen appliances were observed to be clean and in working order.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 69-degree F.

Linen Closet: Contained plenty linens, towels, and hygiene products.