Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan, met with staff Flora and Domingo Calderon for a One (1) year required visit for this facility. Staff called the administrator Mary Jane Rivera who arrived at the facility twenty (20) minutes later. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 9:13 AM and the following was noted:

There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has four (4) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is licensed to care for six (6) non-ambulatory resident and 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 the dining room. The facility maintains a comfortable temperature at 76°F. The smoke detectors were tested and observed to be operational. There is a fire extinguisher located in the kitchen and was observed to be full and last serviced on 03/28/25.

The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a locked shed being used as a used equipment storage.