Facility Evaluation Report

On 05/29/2025 at 10:24 am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Leia Joaquin (Administrator) and the purpose of the visit was discussed. Facility is licensed to serve age 60 and above, 5 non- ambulatory residents of which one (1) may be bedridden and a waiver granted for an approved hospice care for one (1) resident. (2) of the residents are diagnosed with dementia, one (1) residents receive home health, and one (1) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money.

The facility has a current administrator certificate (#7002310740) for Leia Joaquin valid for 09/10/2023 - 09/09/2025. The facility fees were paid on 05/29/2025 at 11:37am (approval code 032432 | confirmation code 969736). The facility has commercial general liability insurance (policy # PCI87489965-03) with Primary Care Insurance, a Risk Retention Group, Inc. (NAIC 16959) with an effective date as 12/09/2024 - 2025 with each occurrence $1,000,000 and general aggregate $3,000,000.

The home is a single home consisting of: (6) resident bedrooms, (3) bathrooms, living room, kitchen with two (2) dining area, a attached garage (locked) which house a washer, dryer and a deep freezer and an outdoor shaded patio area, with a backyard.

Between the hours 10:50am - 11:12am, LPA toured the facility resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place.