Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan met with Administrator Emiliano Siapno for a One (1) Year Required visit for this facility. LPA informed the Administrator the purpose of the visit.

There is only one entrance being utilized at the facility. The facility had submitted and approved Mitigation and Infection Plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

A tour of the physical plant was conducted with Mr. Siapno at 12:16 PM. The facility is a single storey building with six (6) private bedrooms and five (5) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents, all of which may be bedridden. Hospice waiver for six (6) residents.

Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted:

Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and last bought on 01/12/26. The facility is equipped with sprinkler system. There is a carbon monoxide detector installed at the facility.