Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility today. LPA met with Assistant Administrator Glacie San Juan and explained the purpose of this visit.

A tour of the physical plant was conducted at 11:55 AM and the following was observed:

The facility is within a compound and has only one main gate entrance. There is only one main door of the facility being used. The screening station is located immediately upon entrance. The facility has an approved mitigation and infection plan on file.

The facility is a single storey building with three (3) other Residential Care Facility for the Elderly (RCFE) facilities inside the compound. There are five (5) resident bedrooms, four (4) private, one (1) with with own bathroom and one (1) shared room. There are three (3) total bathrooms. Resident bedrooms were observed to be appropriately furnished. The facility is fire cleared for six (6) non-ambulatory residents, all of which maybe bedridden. Hospice waiver for six (6) residents.

Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 74°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected, tested and observed to be operational. There is a Fire extinguisher located in the kitchen last bought on 03/27/25. The facility is equipped with sprinkler system.