Facility Evaluation Report

At 1:45 PM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Gina Jamilano who granted access to the facility. The staff contacted the Administrator Rosalie Tabayoyong via telephone and LPA explained the purpose of the visit. The Administrator arrived shortly after. 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 single-story 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 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 observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA observed knives and sharps located in kitchen cabinet, to be inaccessible to one (1) out of one (1) resident in care. LPA observed several Lysol disinfectant wipes and other cleaning solution sprays on the top of the kitchen sink and accessible to a one (1) out of one (1) resident in care. 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.